Provider Demographics
NPI:1124107248
Name:THORNAPPLE TOWNSHIP
Entity type:Organization
Organization Name:THORNAPPLE TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOWNSHIP TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVALUSKIS-BUCKOWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-795-7202
Mailing Address - Street 1:128 HIGH STREET
Mailing Address - Street 2:PO BOX 459
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-0459
Mailing Address - Country:US
Mailing Address - Phone:269-795-3350
Mailing Address - Fax:269-795-7051
Practice Address - Street 1:128 HIGH STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-0459
Practice Address - Country:US
Practice Address - Phone:269-795-3350
Practice Address - Fax:269-795-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0810043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI990008613OtherRR MEDICARE
MI3003697Medicaid
MI590Z80010OtherBCBSM
MI990008613OtherRR MEDICARE