Healthcare Provider Details

I. General information

NPI: 1104905181
Provider Name (Legal Business Name): VILLAGE OF BUCKLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 INDUSTRIAL DR
BUCKLEY MI
49620-0113
US

IV. Provider business mailing address

106 INDUSTRIAL DR
BUCKLEY MI
49620-0113
US

V. Phone/Fax

Practice location:
  • Phone: 231-269-3702
  • Fax:
Mailing address:
  • Phone: 231-269-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number831005
License Number StateMI

VIII. Authorized Official

Name: MR. DAVID DUFF
Title or Position: DIRECTOR
Credential: DC
Phone: 231-269-3702