1730119504 NPI number — CITY OF SOUTHFIELD

Table of content: (NPI 1730119504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730119504 NPI number — CITY OF SOUTHFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SOUTHFIELD
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:
1730119504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2055
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48037-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-796-5650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24477 LAHSER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-6042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-796-5608
Provider Business Practice Location Address Fax Number:
248-796-5605
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLOMBO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CAPTAIN/ PARAMEDIC COORDINATOR
Authorized Official Telephone Number:
248-796-5608

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  631018 , 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: P00208625 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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