Provider Demographics
NPI:1689610693
Name:CITY OF HAZEL PARK
Entity Type:Organization
Organization Name:CITY OF HAZEL PARK
Other - Org Name:HAZEL PARK FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-542-6000
Mailing Address - Street 1:111 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1845
Mailing Address - Country:US
Mailing Address - Phone:248-542-6000
Mailing Address - Fax:248-546-4086
Practice Address - Street 1:22830 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1819
Practice Address - Country:US
Practice Address - Phone:248-542-6000
Practice Address - Fax:248-546-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631007341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183002887Medicaid
MI590F300320OtherBCBSM
MI183002887Medicaid