1821107046 NPI number — TOWNSHIP OF GROSSE ILE

Table of content: (NPI 1821107046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821107046 NPI number — TOWNSHIP OF GROSSE ILE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWNSHIP OF GROSSE ILE
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:
GROSSE ILE TOWNSHIP FIRE DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1821107046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 GROH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE ILE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48138-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-676-7157
Provider Business Mailing Address Fax Number:
734-692-9694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24525 MERIDIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROSSE ILE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48138-2149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-676-7157
Provider Business Practice Location Address Fax Number:
734-692-9694
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DARZNIEK
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
734-676-4422

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  821009 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590008985 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 590H200190 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 182987207 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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