Provider Demographics
NPI:1730119504
Name:CITY OF SOUTHFIELD
Entity Type:Organization
Organization Name:CITY OF SOUTHFIELD
Other - Org Name:SOUTHFIELD FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN/ PARAMEDIC COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC-IC
Authorized Official - Phone:248-796-5608
Mailing Address - Street 1:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-2055
Mailing Address - Country:US
Mailing Address - Phone:248-796-5650
Mailing Address - Fax:
Practice Address - Street 1:24477 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-6042
Practice Address - Country:US
Practice Address - Phone:248-796-5608
Practice Address - Fax:248-796-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI631018341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00208625OtherRAILROAD MEDICARE
MIP00208625OtherRAILROAD MEDICARE