MEDICARE: PRESQUE ISLE TOWNSHIP

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

General Provider Information

NPI Number	:	1518733062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESQUE ISLE TOWNSHIP

Provider Business Mailing Address
First Line	:	12653 E GRAND LAKE RD
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-8307
Country	:	US
Telephone Number	:	989-595-2752
Fax Number	:

Provider Business Practice Location Address
First Line	:	24335 US 23 S
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-9113
Country	:	US
Telephone Number	:	989-595-3423
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	WILLIAM FORBUSH
Credential	:
Telephone Number	:	989-595-2752

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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Directions to “PRESQUE ISLE TOWNSHIP ” Practice Location

Language	Start Address	Practice Location

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