Provider Demographics
NPI:1386670933
Name:CITY OF STURGIS
Entity Type:Organization
Organization Name:CITY OF STURGIS
Other - Org Name:STURGIS DEPARTMENT OF PUBLIC SAFETY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANASZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-659-7236
Mailing Address - Street 1:124 N NOTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1433
Mailing Address - Country:US
Mailing Address - Phone:269-625-0844
Mailing Address - Fax:269-659-7203
Practice Address - Street 1:124 N NOTTAWA ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1433
Practice Address - Country:US
Practice Address - Phone:269-625-0844
Practice Address - Fax:269-659-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI751008146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4613215Medicaid
MI4613215Medicaid