Healthcare Provider Details

I. General information

NPI: 1902985997
Provider Name (Legal Business Name): ELK RAPIDS TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BRIDGE ST
ELK RAPIDS MI
49629
US

IV. Provider business mailing address

PO BOX 365
ELK RAPIDS MI
49629-0365
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-9333
  • Fax:
Mailing address:
  • Phone: 231-264-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number051005
License Number StateMI

VIII. Authorized Official

Name: MRS. CAROLYN BOALS
Title or Position: TOWNSHIP CLERK
Credential:
Phone: 231-264-9333