Provider Demographics
NPI:1366487407
Name:ADDISON TOWNSHIP
Entity Type:Organization
Organization Name:ADDISON TOWNSHIP
Other - Org Name:ADDISON TWP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-628-5600
Mailing Address - Street 1:4026 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-1909
Mailing Address - Country:US
Mailing Address - Phone:248-628-5600
Mailing Address - Fax:248-628-5770
Practice Address - Street 1:4026 FOREST ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-1909
Practice Address - Country:US
Practice Address - Phone:248-628-5600
Practice Address - Fax:248-628-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631068341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18303722Medicaid
MI590F300070OtherBCBSM
MITYPE 18 3203722Medicaid
MITYPE 18 3203722Medicaid