Organization
POTTERVILLE BENTON TOWNSHIP FIRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK FOX (FIRE CHIEF)
(517) 231-3653
Entity
Organization
Contact information
Practice address
4713 HARTEL RD, POTTERVILLE, MI 48876-9702
(517) 231-3653
Mailing address
1701 LAKE LANSING RD, SUITE 100, LANSING, MI 48912-3798
(517) 485-0001
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
231002
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3003310
—
MI
01
—
590B30011
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/11/2006
Last updated
08/22/2020
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