MEDICARE: CITY OF PORTLAND

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	341005	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

General Provider Information

NPI Number	:	1962498618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF PORTLAND

Provider Business Mailing Address
First Line	:	259 KENT ST
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1458
Country	:	US
Telephone Number	:	517-647-2935
Fax Number	:	517-647-2940

Provider Business Practice Location Address
First Line	:	773 E GRAND RIVER AVE
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-1478
Country	:	US
Telephone Number	:	517-647-2935
Fax Number	:	517-647-2940

Authorized Official
Title or Position	:	CITY MANAGER
Name	:	THOMAS JAMES DEMPSEY
Credential	:
Telephone Number	:	517-647-2931

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/18/2008

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Directions to “CITY OF PORTLAND ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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