1578767893 NPI number — TORCH LAKE TOWNSHIP

Table of content: (NPI 1578767893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578767893 NPI number — TORCH LAKE TOWNSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TORCH LAKE TOWNSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578767893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713
Provider Second Line Business Mailing Address:
2355 US 31 N
Provider Business Mailing Address City Name:
EASTPORT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49627-0713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-599-2174
Provider Business Mailing Address Fax Number:
231-599-2174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 US 31 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTPORT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-599-2174
Provider Business Practice Location Address Fax Number:
231-599-2174
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
231-599-2036

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 900016725 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 590Z5-00080 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 183453289 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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