Provider Demographics
NPI:1255401410
Name:TOWN OF REPUBLIC
Entity type:Organization
Organization Name:TOWN OF REPUBLIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-376-8827
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MI
Mailing Address - Zip Code:49879-0338
Mailing Address - Country:US
Mailing Address - Phone:906-376-8827
Mailing Address - Fax:906-376-2383
Practice Address - Street 1:9610 STATE HWY M95
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MI
Practice Address - Zip Code:49879
Practice Address - Country:US
Practice Address - Phone:906-376-8827
Practice Address - Fax:906-376-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3004406Medicaid
MI0E20008Medicare ID - Type UnspecifiedAMBULANCE
MI3004406Medicaid