Provider Demographics
NPI:1538103619
Name:CHARTER TOWNSHIP OF WEST BLOOMFIELD
Entity Type:Organization
Organization Name:CHARTER TOWNSHIP OF WEST BLOOMFIELD
Other - Org Name:WEST BLOOMFIELD TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT P IC
Authorized Official - Phone:248-409-1505
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:5425 W. MAPLE RD.
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3035
Practice Address - Country:US
Practice Address - Phone:248-409-1505
Practice Address - Fax:248-406-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI341600000X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18 4579051Medicaid
MI590F302170OtherBCBSM
MI0N88580Medicare ID - Type Unspecified