1053347559 NPI number — COLOMA EMERGENCY AMBULANCE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053347559 NPI number — COLOMA EMERGENCY AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLOMA EMERGENCY AMBULANCE, 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:
PRIDE CARE AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1053347559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2288
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49003-2288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-343-2224
Provider Business Mailing Address Fax Number:
269-343-6503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5088 MEREDITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49002-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-343-2224
Provider Business Practice Location Address Fax Number:
269-343-6503
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEILL
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
269-343-2224

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  111002 , 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: 590A100510 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 182675246 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2675246 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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