Healthcare Provider Details

I. General information

NPI: 1386670933
Provider Name (Legal Business Name): CITY OF STURGIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N NOTTAWA ST
STURGIS MI
49091-1433
US

IV. Provider business mailing address

124 N NOTTAWA ST
STURGIS MI
49091-1433
US

V. Phone/Fax

Practice location:
  • Phone: 269-625-0844
  • Fax: 269-659-7203
Mailing address:
  • Phone: 269-625-0844
  • Fax: 269-659-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number751008
License Number StateMI

VIII. Authorized Official

Name: RYAN BANASZAK
Title or Position: DIRECTOR
Credential:
Phone: 269-659-7236