1427046481 NPI number — LESLIE AREA AMBULANCE SERVICE, INC.

Table of content: (NPI 1427046481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427046481 NPI number — LESLIE AREA AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESLIE AREA AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427046481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E BELLEVUE ST
Provider Second Line Business Mailing Address:
PO BOX 461
Provider Business Mailing Address City Name:
LESLIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49251-9373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-589-9141
Provider Business Mailing Address Fax Number:
517-589-9819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E BELLEVUE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LESLIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49251-9373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-589-9141
Provider Business Practice Location Address Fax Number:
517-589-9819
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SWIFT
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
BOOKKEEPER,BILLER
Authorized Official Telephone Number:
517-589-9141

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  331005 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OC30020 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 81-09470 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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