# POTTERVILLE BENTON TOWNSHIP FIRE

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

## Provider details

- **NPI number:** 1508808106
- **Authorized official:** JACK FOX (FIRE CHIEF)
- **Authorized official phone:** (517) 231-3653

## Contact information

- **Practice address:** 4713 HARTEL RD, POTTERVILLE, MI 48876-9702
- **Practice address phone:** (517) 231-3653
- **Mailing address:** 1701 LAKE LANSING RD, SUITE 100, LANSING, MI 48912-3798
- **Mailing address phone:** (517) 485-0001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 231002 | MI | Yes |

## Other

- **Enumeration date:** 06/11/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3003310 | — | MI |
| 01 | — | 590B30011 | BLUE CROSS BLUE SHIELD | MI |