Provider Demographics
NPI:1619029980
Name:TOWNSHIP OF PORTAGE
Entity Type:Organization
Organization Name:TOWNSHIP OF PORTAGE
Other - Org Name:PORTAGE TOWNSHIP AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLACHLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-586-9522
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CURTIS
Mailing Address - State:MI
Mailing Address - Zip Code:49820-0070
Mailing Address - Country:US
Mailing Address - Phone:906-586-9522
Mailing Address - Fax:906-586-3360
Practice Address - Street 1:W17361 DAVIS STREET
Practice Address - Street 2:
Practice Address - City:CURTIS
Practice Address - State:MI
Practice Address - Zip Code:49820-0070
Practice Address - Country:US
Practice Address - Phone:906-586-3574
Practice Address - Fax:906-586-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4910053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI18-1804071Medicaid
MI590D90006OtherBLUE CROSS BLUE SHIELD OF MI
MI0D90006Medicare PIN