Provider Demographics
NPI:1740510924
Name:ST. JOSEPH CO. AIRPORT AUTHORITY
Entity type:Organization
Organization Name:ST. JOSEPH CO. AIRPORT AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ORNAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-282-4593
Mailing Address - Street 1:4821 LINCOLN WAY W
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-5525
Mailing Address - Country:US
Mailing Address - Phone:574-282-4593
Mailing Address - Fax:574-282-4592
Practice Address - Street 1:4821 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-5525
Practice Address - Country:US
Practice Address - Phone:574-282-4593
Practice Address - Fax:574-282-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0444343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)