=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558301226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUTTONS BAY-BINGHAM FIRE & RESCUE AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 03/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S. ST MARYS AVE
-----------------------------------------------------
City | SUTTONS BAY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-271-6978
-----------------------------------------------------
Fax | 231-271-5742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2122
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48193-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-479-6300
-----------------------------------------------------
Fax | 734-479-6319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | JAMES PORTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-271-6978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 451005
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 451005
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------