1235152240 NPI number — WAYNE TOWNSHIP MARION CO OFFICE OF TRUSTEE

Table of content: (NPI 1235152240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235152240 NPI number — WAYNE TOWNSHIP MARION CO OFFICE OF TRUSTEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYNE TOWNSHIP MARION CO OFFICE OF TRUSTEE
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:
6
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:
1235152240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 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:
48193-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-224-4474
Provider Business Mailing Address Fax Number:
734-479-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 N HIGH SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46214-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-246-6244
Provider Business Practice Location Address Fax Number:
317-246-6372
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
OWEN
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
317-619-0486

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100288480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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