Organization
WAYNE COUNTY AIRPORT AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLEN O'SUCH (FIRE CHIEF)
(734) 942-3602
Entity
Organization
Contact information
Practice address
DETROIT METRO WILLOW RUN, DETROIT, MI 48242
(734) 247-7364
(734) 942-3667
Mailing address
11050 ROGELL DR # 602, DETROIT, MI 48242-1144
(734) 942-3602
(734) 247-7332
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
821065
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184590433
—
MI
01
—
P00146362
RR MEDICARE
MI
Enumeration date
06/15/2006
Last updated
02/23/2022
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