Healthcare Provider Details

I. General information

NPI: 1659334860
Provider Name (Legal Business Name): MERIDIAN CHARTER TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MARSH RD
OKEMOS MI
48864-1104
US

IV. Provider business mailing address

5151 MARSH RD
OKEMOS MI
48864-1104
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-4700
  • Fax: 517-853-4097
Mailing address:
  • Phone: 517-853-4700
  • Fax: 517-853-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number331007
License Number StateMI

VIII. Authorized Official

Name: MR. FREDERICK COWPER
Title or Position: FIRE CHIEF
Credential:
Phone: 517-853-4700