Provider Demographics
NPI:1275694622
Name:TOWNSHIP OF DENTON ROSCOMMON COUNTY
Entity Type:Organization
Organization Name:TOWNSHIP OF DENTON ROSCOMMON COUNTY
Other - Org Name:DENTON TOWNSHIP AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-366-8083
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-224-4474
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:1301 W WEST BRANCH RD
Practice Address - Street 2:
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48651-9465
Practice Address - Country:US
Practice Address - Phone:989-366-8083
Practice Address - Fax:989-366-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI721009341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590008104OtherRR MEDICARE
MI182595065Medicaid
MI0G20207Medicare PIN