Provider Demographics
NPI:1871530246
Name:CHARTER TOWNSHIP OF INDEPENDENCE
Entity type:Organization
Organization Name:CHARTER TOWNSHIP OF INDEPENDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-625-1924
Mailing Address - Street 1:6500 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2986
Mailing Address - Country:US
Mailing Address - Phone:248-625-1924
Mailing Address - Fax:
Practice Address - Street 1:6500 CITATION DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2986
Practice Address - Country:US
Practice Address - Phone:248-625-1924
Practice Address - Fax:248-625-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI341600000X341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590015476OtherRAILROAD MEDICARE
MI184237180Medicaid
MI590F322300OtherBLUE CROSS