Provider Demographics
NPI:1386688497
Name:TOWNSHIP OF LEELANAU
Entity Type:Organization
Organization Name:TOWNSHIP OF LEELANAU
Other - Org Name:NORTHPORT EMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-386-9073
Mailing Address - Street 1:119 E. NAGONABA ST.
Mailing Address - Street 2:P.O. BOX 338
Mailing Address - City:NORTHPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670
Mailing Address - Country:US
Mailing Address - Phone:231-386-5138
Mailing Address - Fax:
Practice Address - Street 1:100 EIGHTH ST.
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:MI
Practice Address - Zip Code:49670-0338
Practice Address - Country:US
Practice Address - Phone:231-386-9073
Practice Address - Fax:231-386-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI451003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18-4338370Medicaid
MI0P12540Medicare PIN