Provider Demographics
NPI:1982892444
Name:NORMAN TOWNSHIP
Entity Type:Organization
Organization Name:NORMAN TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:231-510-5400
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:17206 8TH STREET
Mailing Address - City:WELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49689-0143
Mailing Address - Country:US
Mailing Address - Phone:231-848-4495
Mailing Address - Fax:231-848-4495
Practice Address - Street 1:17206 8TH STREET
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49689-0143
Practice Address - Country:US
Practice Address - Phone:231-848-4495
Practice Address - Fax:231-848-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI511002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2729365Medicaid
MI590E110260OtherBLUE CROSS BLUE SHIELD
MI590E110260OtherBCBS
MI590E110260OtherBCBS