1811060965 NPI number — STOCKBRIDGE AREA EMERGENCY SERVICES AUTHORITY

Table of content: (NPI 1811060965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811060965 NPI number — STOCKBRIDGE AREA EMERGENCY SERVICES AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOCKBRIDGE AREA EMERGENCY SERVICES AUTHORITY
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:
S.A.E.S.A.
Provider Other Organization Name Type Code:
5
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:
1811060965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 728
Provider Second Line Business Mailing Address:
125 S. CENTER ST
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-851-7943
Provider Business Mailing Address Fax Number:
517-851-7645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 S. CLINTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-851-7943
Provider Business Practice Location Address Fax Number:
517-851-7645
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
517-851-7943

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0C30014 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1777644 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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