Provider Demographics
NPI:1902021355
Name:HIGGINS TOWNSHIP ROSCOMMON COUNTY MICH
Entity Type:Organization
Organization Name:HIGGINS TOWNSHIP ROSCOMMON COUNTY MICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE AND EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-275-5229
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:700 SOUTH FIFTH STREET
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653
Practice Address - Country:US
Practice Address - Phone:989-275-8112
Practice Address - Fax:989-275-8990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGGINS TOWNSHIP EMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI721008341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI181971418Medicaid
MI590G200070OtherBLUE CROSS
MI0G20007Medicare ID - Type Unspecified