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General NPI Number Information
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NPI Number | 1942257076
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Entity Type | Organization
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Legal Business Name | CITY OF MANISTIQUE
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 300 N MAPLE ST
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City | MANISTIQUE
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State | MI
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Zip | 49854-1216
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Country | US
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Telephone | 906-341-2134
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Fax | 906-341-0106
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | MANISTIQUE
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State | MI
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Zip | 49854-0515
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Country | US
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Telephone | 906-341-2134
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TIMOTHY CHARLES RUSSELL
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Credential |
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Telephone | 906-341-2134
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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 | 771001
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License Number State | MI
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