MEDICARE: LYON TOWNSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	631050	MI

General Provider Information

NPI Number	:	1023463833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYON TOWNSHIP

Provider Business Mailing Address
First Line	:	PO BOX 2122
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-1122
Country	:	US
Telephone Number	:	800-926-6985
Fax Number	:	734-479-6319

Provider Business Practice Location Address
First Line	:	58800 GRAND RIVER AVE
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-9721
Country	:	US
Telephone Number	:	248-486-3775
Fax Number	:	248-486-8884

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	REGINALD D MADELINE JR.
Credential	:
Telephone Number	:	248-486-3775

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	01/22/2024

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Directions to “LYON TOWNSHIP ” Practice Location

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