Healthcare Provider Details

I. General information

NPI: 1548739063
Provider Name (Legal Business Name): CITY OF LINCOLN PARK / LINCOLN PARK FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 CLEOPHUS PKWY
LINCOLN PARK MI
48146-2301
US

IV. Provider business mailing address

1355 CLEOPHUS PKWY
LINCOLN PARK MI
48146-2301
US

V. Phone/Fax

Practice location:
  • Phone: 313-381-1100
  • Fax: 313-381-1831
Mailing address:
  • Phone: 313-381-1100
  • Fax: 313-381-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STEVE MARTIN
Title or Position: FIRE CHIEF
Credential:
Phone: 313-381-1100