Healthcare Provider Details

I. General information

NPI: 1124107248
Provider Name (Legal Business Name): THORNAPPLE TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 HIGH STREET
MIDDLEVILLE MI
49333-0459
US

IV. Provider business mailing address

128 HIGH STREET PO BOX 459
MIDDLEVILLE MI
49333-0459
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-3350
  • Fax: 269-795-7051
Mailing address:
  • Phone: 269-795-3350
  • Fax: 269-795-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number081004
License Number StateMI

VIII. Authorized Official

Name: MS. DEBRA KAVALUSKIS-BUCKOWING
Title or Position: TOWNSHIP TREASURER
Credential:
Phone: 269-795-7202