Provider Demographics
NPI:1558443051
Name:WHITEFISH TOWNSHIP
Entity Type:Organization
Organization Name:WHITEFISH TOWNSHIP
Other - Org Name:WHITEFISH TOWNSHIP EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-495-6062
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:MI
Mailing Address - Zip Code:49768-0350
Mailing Address - Country:US
Mailing Address - Phone:906-492-3317
Mailing Address - Fax:
Practice Address - Street 1:7009 N. HWY. M-123
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:MI
Practice Address - Zip Code:49768
Practice Address - Country:US
Practice Address - Phone:906-492-3317
Practice Address - Fax:906-492-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171017341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI184134890Medicaid
MI0A70011Medicare PIN