Provider Demographics
NPI:1841380052
Name:VILLAGE OF MACKINAW CITY
Entity Type:Organization
Organization Name:VILLAGE OF MACKINAW CITY
Other - Org Name:VILLAGE OF MACKINAW CITY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VILLAGE TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PEPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-436-5351
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:102 S HURON AVE
Mailing Address - City:MACKINAW CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49701
Mailing Address - Country:US
Mailing Address - Phone:231-436-5351
Mailing Address - Fax:231-436-4166
Practice Address - Street 1:102 S. HURON
Practice Address - Street 2:
Practice Address - City:MACKINAW CITY
Practice Address - State:MI
Practice Address - Zip Code:49701
Practice Address - Country:US
Practice Address - Phone:231-436-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A60005OtherBLUE CROSS BLUE SHIELD
MI0A60005Medicare PIN