# WAYNE COUNTY AIRPORT AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194769828
- **Authorized official:** MR. GLEN O'SUCH (FIRE CHIEF)
- **Authorized official phone:** (734) 942-3602

## Contact information

- **Practice address:** DETROIT METRO WILLOW RUN, DETROIT, MI 48242
- **Practice address phone:** (734) 247-7364
- **Practice address fax:** (734) 942-3667
- **Mailing address:** 11050 ROGELL DR \# 602, DETROIT, MI 48242-1144
- **Mailing address phone:** (734) 942-3602
- **Mailing address fax:** (734) 247-7332

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 821065 | MI | Yes |

## Other

- **Enumeration date:** 06/15/2006
- **Last updated:** 02/23/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 184590433 | — | MI |
| 01 | — | P00146362 | RR MEDICARE | MI |