Healthcare Provider Details

I. General information

NPI: 1972784254
Provider Name (Legal Business Name): TOWNSHIP OF IRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7085 MELDRUM RD
IRA MI
48023-2427
US

IV. Provider business mailing address

PO BOX 2122
RIVERVIEW MI
48193-1122
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-0263
  • Fax: 586-725-8790
Mailing address:
  • Phone: 734-479-6300
  • Fax: 734-479-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number741018
License Number StateMI

VIII. Authorized Official

Name: MR. ROBERT MCCOY
Title or Position: SUPERVISOR
Credential:
Phone: 586-725-0263