Provider Demographics
NPI:1700867520
Name:VILLAGE OF THOMPSONVILLE
Entity Type:Organization
Organization Name:VILLAGE OF THOMPSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-378-2641
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49683-0184
Mailing Address - Country:US
Mailing Address - Phone:231-378-2641
Mailing Address - Fax:231-378-2641
Practice Address - Street 1:14714 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49683-9109
Practice Address - Country:US
Practice Address - Phone:231-378-2641
Practice Address - Fax:231-378-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1010023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590A000040OtherBCBS
MI3004317Medicaid
MI590A000040OtherBCBS