Provider Demographics
NPI:1790860278
Name:CLARK TOWNSHIP - MACKINAC COUNTY
Entity Type:Organization
Organization Name:CLARK TOWNSHIP - MACKINAC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP CLERK
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-484-2672
Mailing Address - Street 1:207 N BLINDLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49719
Mailing Address - Country:US
Mailing Address - Phone:906-484-2672
Mailing Address - Fax:906-484-3199
Practice Address - Street 1:212 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:MI
Practice Address - Zip Code:49719
Practice Address - Country:US
Practice Address - Phone:906-484-2672
Practice Address - Fax:906-484-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI491001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183001549Medicaid
MI0D90004Medicare PIN