Healthcare Provider Details

I. General information

NPI: 1003851635
Provider Name (Legal Business Name): CITY OF FLAT ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/05/2024
Certification Date: 10/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 GIBRALTAR RD
FLAT ROCK MI
48134-1335
US

IV. Provider business mailing address

25500 GIBRALTAR RD
FLAT ROCK MI
48134-1335
US

V. Phone/Fax

Practice location:
  • Phone: 734-789-2338
  • Fax: 734-783-0316
Mailing address:
  • Phone: 734-789-2338
  • Fax: 734-783-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number82 1006
License Number StateMI

VIII. Authorized Official

Name: DERRICK WELTON
Title or Position: FIRE CHIEF
Credential:
Phone: 734-755-7692