=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386634863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF INKSTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2005
-----------------------------------------------------
Last Update Date | 01/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27717 MICHIGAN AVE
-----------------------------------------------------
City | INKSTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48141-2203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-563-9874
-----------------------------------------------------
Fax | 313-563-6660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 630
-----------------------------------------------------
City | WYANDOTTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48192-0630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-477-4946
-----------------------------------------------------
Fax | 734-246-2990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | OLLICE HUBBARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-323-7438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 084830
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------