Provider Demographics
NPI:1447339411
Name:TOWNSHIP OF BLAIR
Entity type:Organization
Organization Name:TOWNSHIP OF BLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-276-9263
Mailing Address - Street 1:2121 CO RD 633
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9406
Mailing Address - Country:US
Mailing Address - Phone:231-276-9263
Mailing Address - Fax:
Practice Address - Street 1:2121 CO RD 633
Practice Address - Street 2:
Practice Address - City:GRAWN
Practice Address - State:MI
Practice Address - Zip Code:49637-9406
Practice Address - Country:US
Practice Address - Phone:231-276-9263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2810043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590B800060OtherBLUE CROSS BLUE SHIELD
MI3106667Medicaid
MI590B800060OtherBLUE CROSS BLUE SHIELD