# TOWNSHIP OF GREEN LAKE GRAND TRAVERSE COUNTY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Township of Green Lake
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669524948
- **Authorized official:** MR. MICHAEL STINSON (FIRE CAPTAIN)
- **Authorized official phone:** (231) 276-6297

## Contact information

- **Practice address:** 9394 10TH ST, INTERLOCHEN, MI 49643
- **Practice address phone:** (231) 276-6297
- **Practice address fax:** (231) 276-9388
- **Mailing address:** PO BOX 747, WHEELING, IL 60090-0747
- **Mailing address phone:** (800) 244-2345
- **Mailing address fax:** (800) 329-5274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 281005 | MI | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 11/22/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0B80013 | BLUE CROSS BLUE SHIELD | MI |
| 01 | — | 26364 | PRIORITY HEALTH | MI |
| 05 | — | 3295644 | — | MI |