Provider Demographics
NPI:1548495989
Name:CITY OF SOUTHGATE
Entity type:Organization
Organization Name:CITY OF SOUTHGATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:GILDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-658-7691
Mailing Address - Street 1:14400 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2581
Mailing Address - Country:US
Mailing Address - Phone:734-258-3080
Mailing Address - Fax:
Practice Address - Street 1:14400 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2581
Practice Address - Country:US
Practice Address - Phone:734-258-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821069251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare