1225088222 NPI number — DVA 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 1225088222 NPI number — DVA AMBULANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DVA 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:
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:
1225088222
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:
308 N. SAGINAW STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48429-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-288-3177
Provider Business Mailing Address Fax Number:
989-288-6770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 N SAGINAW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48429-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-288-3177
Provider Business Practice Location Address Fax Number:
989-288-6770
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTENSON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
989-288-3177

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  781002 , 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: 0000200 . This is a "GENESEE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1830000499 . This is a "WASHTENAW HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1000137 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "TOTAL HEALTH CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "KALAMAZOO COUNTY HEALTH P" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4528105 . This is a "MID MICHIGAN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 590G80007 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000200 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1221240001 . This is a "CHS THE WELLNESS PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3000499 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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