Provider Demographics
NPI:1750327227
Name:CITY OF GIBRALTAR
Entity Type:Organization
Organization Name:CITY OF GIBRALTAR
Other - Org Name:GIBRALTAR PSD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-341-3543
Mailing Address - Street 1:29450 MUNRO ST
Mailing Address - Street 2:
Mailing Address - City:GIBRALTAR
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9720
Mailing Address - Country:US
Mailing Address - Phone:734-676-1022
Mailing Address - Fax:734-676-5124
Practice Address - Street 1:29450 MUNRO ST
Practice Address - Street 2:
Practice Address - City:GIBRALTAR
Practice Address - State:MI
Practice Address - Zip Code:48173-9720
Practice Address - Country:US
Practice Address - Phone:734-676-5229
Practice Address - Fax:734-676-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8210083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183028140Medicaid
MI590H201150OtherBCBSM
MI183028140Medicaid