Provider Demographics
NPI:1366470296
Name:TOWNSHIP OF PLYMOUTH
Entity Type:Organization
Organization Name:TOWNSHIP OF PLYMOUTH
Other - Org Name:PLYMOUTH COMMUNITY FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-354-3220
Mailing Address - Street 1:9955 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4673
Mailing Address - Country:US
Mailing Address - Phone:517-318-3756
Mailing Address - Fax:
Practice Address - Street 1:9955 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4673
Practice Address - Country:US
Practice Address - Phone:734-354-3221
Practice Address - Fax:734-354-9672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI341600000X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590H200770OtherBCBSM
MI183002377Medicaid
MI183002377Medicaid