Provider Demographics
NPI:1689626848
Name:CHARTER TOWNSHIP OF MADISON LENAWEE CO
Entity Type:Organization
Organization Name:CHARTER TOWNSHIP OF MADISON LENAWEE CO
Other - Org Name:MADISON TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-6560
Mailing Address - Street 1:4008 S ADRIAN HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8723
Mailing Address - Country:US
Mailing Address - Phone:517-265-6560
Mailing Address - Fax:517-263-0108
Practice Address - Street 1:4008 S ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8723
Practice Address - Country:US
Practice Address - Phone:517-265-6560
Practice Address - Fax:517-263-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI461004341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590D600240OtherBLUE CROSS
MIAN0499OtherSELECT CARE
MI3004685Medicaid
MI606493200OtherUSPS WORKERS COMPENSATION
MI81-29089OtherPHYSICIAN HEALTH PLANS
MI50675OtherCOMMUNITY CHOICE MICHIGAN
MI0D60024Medicare PIN