1114120441 NPI number — SUTTONS BAY BINGHAM FIRE RESCUE

Table of content: (NPI 1114120441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114120441 NPI number — SUTTONS BAY BINGHAM FIRE RESCUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTONS BAY BINGHAM FIRE RESCUE
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:
1114120441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. 2122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48193-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-926-6985
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S. ST. MARY'S AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUTTONS BAY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49682-0280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-271-6978
Provider Business Practice Location Address Fax Number:
231-271-5742
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PORTER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
231-271-6978

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  451005 , 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: 590D500090 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 182741950 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com