Healthcare Provider Details

I. General information

NPI: 1891093654
Provider Name (Legal Business Name): LYONS TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PRAIRIE ST
LYONS MI
48851
US

IV. Provider business mailing address

104 PRAIRIE ST
LYONS MI
48851
US

V. Phone/Fax

Practice location:
  • Phone: 989-855-2016
  • Fax: 989-855-2840
Mailing address:
  • Phone: 989-855-2016
  • Fax: 989-855-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: JULIE ANN HECKMAN
Title or Position: DEPUTY CLERK/ BILLING
Credential:
Phone: 989-593-2773