# CITY OF MANISTIQUE

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

## Provider details

- **NPI number:** 1942257076
- **Authorized official:** MR. TIMOTHY CHARLES RUSSELL (DIRECTOR)
- **Authorized official phone:** (906) 341-2134

## Contact information

- **Practice address:** 300 N MAPLE ST, MANISTIQUE, MI 49854-1216
- **Practice address phone:** (906) 341-2134
- **Practice address fax:** (906) 341-0106
- **Mailing address:** PO BOX 515, MANISTIQUE, MI 49854-0515
- **Mailing address phone:** (906) 341-2134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 771001 | MI | Yes |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 03/08/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3000078 | — | MI |
| 01 | — | 590G70001 | BCBS PROVIDER ID\# | MI |