Provider Demographics
NPI:1225243942
Name:TOWNSHIP OF BURT
Entity Type:Organization
Organization Name:TOWNSHIP OF BURT
Other - Org Name:BURT TOWNSHIP BOARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:II
Authorized Official - Credentials:0
Authorized Official - Phone:906-494-2381
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MI
Mailing Address - Zip Code:49839-0430
Mailing Address - Country:US
Mailing Address - Phone:906-494-2381
Mailing Address - Fax:906-494-2627
Practice Address - Street 1:E21788 COAST GUARD POINT RD
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MI
Practice Address - Zip Code:49839-0430
Practice Address - Country:US
Practice Address - Phone:906-494-2381
Practice Address - Fax:906-494-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0210023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI182666739Medicaid
MI0Z20003Medicare PIN