Provider Demographics
NPI:1417035411
Name:SOLON AND CENTERVILLE TWP FIRE DEPT
Entity Type:Organization
Organization Name:SOLON AND CENTERVILLE TWP FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:231-735-5335
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-0208
Mailing Address - Country:US
Mailing Address - Phone:231-228-5396
Mailing Address - Fax:231-228-5395
Practice Address - Street 1:8907 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621-0208
Practice Address - Country:US
Practice Address - Phone:231-228-5396
Practice Address - Fax:231-228-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4510013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3040215Medicaid
MI590D50005OtherBLUE CROSS BLUE SHIELD
MI590D50005OtherBLUE CROSS BLUE SHIELD