Wayne County Airport Authority

Primary specialty

AmbulanceTaxonomy code 341600000X

License

821065 Issued in MI

Legal business name

WAYNE COUNTY AIRPORT AUTHORITY

Practice address

Detroit Metro Willow Run
Detroit, MI 48242

Phone

(734) 247-7364

Fax

(734) 942-3667

NPI assigned

Jun 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Glen O'Such

Title

Fire Chief

Phone

(734) 942-3602

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645574400000",
    "number": "1194769828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 ROGELL DR # 602",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482421144",
            "telephone_number": "734-942-3602",
            "fax_number": "734-247-7332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DETROIT METRO WILLOW RUN",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48242",
            "telephone_number": "734-247-7364",
            "fax_number": "734-942-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE COUNTY AIRPORT AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "O'SUCH",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "734-942-3602",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MI",
            "license": "821065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184590433",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00146362",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wave Medical Center PLLC
• Jonathan Waxman
• Victoria Alexandra Anna Waye, MSN, APRN, FNP-BC
• Wayne Campus Pharmacy LLC
• Wayne Children'S Healthcare Access Program
• Wayne County Children Family Services
• Wayne County Jail
• Wayne County Jail Pharmacy
• Wayne County Juvenile Detention Facility
• Wayne County Patient Care Management System

• Ambulance in Detroit, MI
• Providers in Detroit, MI by specialty
• Ambulance in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.