MEDICARE: CITY OF TRAVERSE CITY

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	281013	MI

General Provider Information

NPI Number	:	1396022109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF TRAVERSE CITY

Provider Business Mailing Address
First Line	:	PO BOX 592
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-0592
Country	:	US
Telephone Number	:	231-922-4930
Fax Number	:	231-922-4872

Provider Business Practice Location Address
First Line	:	400 BOARDMAN AVE
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2542
Country	:	US
Telephone Number	:	231-922-4930
Fax Number	:	231-922-4872

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. JAMES TULLER
Credential	:
Telephone Number	:	231-922-4930

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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Directions to “CITY OF TRAVERSE CITY ” Practice Location

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