1790724656 NPI number — CITY OF TAYLOR

Table of content: (NPI 1790724656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790724656 NPI number — CITY OF TAYLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF TAYLOR
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:
1790724656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2023
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:
800-926-6985
Provider Business Mailing Address Fax Number:
734-479-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23345 GODDARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-4163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-374-1660
Provider Business Practice Location Address Fax Number:
734-374-2742
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PORTIS
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
734-374-1355

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  821026 , 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: 183005430 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590013724 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 590H201190 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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