Provider Demographics
NPI:1700252558
Name:CITY OF BELLEVILLE
Entity Type:Organization
Organization Name:CITY OF BELLEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIEUTENANT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-394-6892
Mailing Address - Street 1:6 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2736
Mailing Address - Country:US
Mailing Address - Phone:734-394-6892
Mailing Address - Fax:
Practice Address - Street 1:25 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2707
Practice Address - Country:US
Practice Address - Phone:734-394-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821052146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty