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General NPI Number Information
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NPI Number | 1306997598
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Entity Type | Organization
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Legal Business Name | EAST BAY CHARTER TOWNSHIP
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 110 HIGH LAKE RD
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-8136
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Country | US
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Telephone | 231-947-0299
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Fax | 231-947-0602
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Provider Business Mailing Address
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Address Line | 110 HIGH LAKE RD
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-8136
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Country | US
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Telephone | 231-947-0299
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Fax |
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Authorized Official
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Title or Position | AMBULANCE DIRECTOR
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Name | NICHOLAS LEMCOOL
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Credential |
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Telephone | 231-947-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 28 1001
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License Number State | MI
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