Healthcare Provider Details

I. General information

NPI: 1942257076
Provider Name (Legal Business Name): CITY OF MANISTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAPLE ST
MANISTIQUE MI
49854-1216
US

IV. Provider business mailing address

PO BOX 515
MANISTIQUE MI
49854-0515
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-2134
  • Fax: 906-341-0106
Mailing address:
  • Phone: 906-341-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number771001
License Number StateMI

VIII. Authorized Official

Name: MR. TIMOTHY CHARLES RUSSELL
Title or Position: DIRECTOR
Credential:
Phone: 906-341-2134