Provider Demographics
NPI:1063423473
Name:TWIN TOWNSHIP AMBULANCE, INC.
Entity type:Organization
Organization Name:TWIN TOWNSHIP AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-634-1001
Mailing Address - Street 1:7900 SAGINAW ST
Mailing Address - Street 2:P.O. BOX 303
Mailing Address - City:NEW LOTHROP
Mailing Address - State:MI
Mailing Address - Zip Code:48460
Mailing Address - Country:US
Mailing Address - Phone:810-634-1001
Mailing Address - Fax:810-638-7424
Practice Address - Street 1:7900 SAGINAW ST
Practice Address - Street 2:
Practice Address - City:NEW LOTHROP
Practice Address - State:MI
Practice Address - Zip Code:48460-9688
Practice Address - Country:US
Practice Address - Phone:810-638-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7810073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3004513Medicaid
MI71020000G80017OtherBLUE CROSS BLUE SHIELD
MI3004513Medicaid