MEDICARE: ADDISON 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	341600000X	Ambulance	631068	MI
2	3416L0300X	Land Ambulance	631068	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	590F300070	OTHER	MI	BCBSM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366487407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDISON TOWNSHIP

Provider Business Mailing Address
First Line	:	4026 FOREST ST
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-1909
Country	:	US
Telephone Number	:	248-628-5600
Fax Number	:	248-628-5770

Provider Business Practice Location Address
First Line	:	4026 FOREST ST
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-1909
Country	:	US
Telephone Number	:	248-628-5600
Fax Number	:	248-628-5770

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JERRY R MORAWSKI
Credential	:
Telephone Number	:	248-628-5600

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	06/19/2012

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Directions to “ADDISON TOWNSHIP ” Practice Location

Language	Start Address	Practice Location

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