MEDICARE: CITY OF INKSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	084830	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	590H20068	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1386634863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF INKSTER

Provider Business Mailing Address
First Line	:	PO BOX 630
Second Line	:
City	:	WYANDOTTE
State	:	MI
Zip	:	48192-0630
Country	:	US
Telephone Number	:	877-477-4946
Fax Number	:	734-246-2990

Provider Business Practice Location Address
First Line	:	27717 MICHIGAN AVE
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2203
Country	:	US
Telephone Number	:	313-563-9874
Fax Number	:	313-563-6660

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	OLLICE HUBBARD
Credential	:
Telephone Number	:	734-323-7438

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	01/09/2024

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Directions to “CITY OF INKSTER ” Practice Location

Language	Start Address	Practice Location

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