MEDICARE: TOWNSHIP OF LONG LAKE

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

General Provider Information

NPI Number	:	1497412886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNSHIP OF LONG LAKE

Provider Business Mailing Address
First Line	:	8870 N LONG LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-9622
Country	:	US
Telephone Number	:	231-946-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	8870 N LONG LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-9622
Country	:	US
Telephone Number	:	231-946-2249
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	MS. KIMBERLY KAY DELEON
Credential	:
Telephone Number	:	231-421-3159

Provider Enumeration Date	:	11/21/2021
Last Update Date	:	04/08/2022

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Directions to “TOWNSHIP OF LONG LAKE ” Practice Location

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