Provider Demographics
NPI:1700815636
Name:TOWNSHIP OF FORSYTH
Entity Type:Organization
Organization Name:TOWNSHIP OF FORSYTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-346-9217
Mailing Address - Street 1:186 W FLINT ST
Mailing Address - Street 2:P.O. BOX 1360
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9572
Mailing Address - Country:US
Mailing Address - Phone:906-346-9217
Mailing Address - Fax:906-346-3267
Practice Address - Street 1:186 W FLINT ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-9572
Practice Address - Country:US
Practice Address - Phone:906-346-9217
Practice Address - Fax:906-346-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI521001146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid
MION 28550Medicare ID - Type Unspecified