1689626848 NPI number — CHARTER TOWNSHIP OF MADISON LENAWEE CO

Table of content: (NPI 1689626848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689626848 NPI number — CHARTER TOWNSHIP OF MADISON LENAWEE CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARTER TOWNSHIP OF MADISON LENAWEE CO
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:
1689626848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4008 S ADRIAN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADRIAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49221-8723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-265-6560
Provider Business Mailing Address Fax Number:
517-263-0108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4008 S ADRIAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADRIAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49221-8723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-265-6560
Provider Business Practice Location Address Fax Number:
517-263-0108
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
517-265-6560

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  461004 , 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: 590D600240 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: AN0499 . This is a "SELECT CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3004685 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606493200 . This is a "USPS WORKERS COMPENSATION" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 81-29089 . This is a "PHYSICIAN HEALTH PLANS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50675 . This is a "COMMUNITY CHOICE MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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