=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407347198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE OF HOLLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2018
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 N SAGINAW ST
-----------------------------------------------------
City | HOLLY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48442-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-531-6010
-----------------------------------------------------
Fax | 248-531-6012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 N SAGINAW ST
-----------------------------------------------------
City | HOLLY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48442-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-531-6010
-----------------------------------------------------
Fax | 734-479-6319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | JEREMY CAMERON WATSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-875-0236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------