# SISTER LAKES FIRE DEPARTMENT

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

## Provider details

- **NPI number:** 1366487753
- **Authorized official:** MS. GAYLE TIDEY (PRESIDENT)
- **Authorized official phone:** (269) 424-3145

## Contact information

- **Practice address:** 92280 COUNTY ROAD 690, DOWAGIAC, MI 49047-9035
- **Practice address phone:** (269) 424-3145
- **Practice address fax:** (269) 424-5560
- **Mailing address:** 92280 COUNTY ROAD 690, DOWAGIAC, MI 49047-9035
- **Mailing address phone:** (269) 424-3145
- **Mailing address fax:** (269) 424-5560

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 801005 | MI | Yes |

## Other

- **Enumeration date:** 06/18/2006
- **Last updated:** 03/12/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2789837 | — | MI |
| 01 | — | 590H000014 | BCBS | — |