1689777237 NPI number — ONAWAY AREA AMBULANCE SERVICE

Table of content: (NPI 1689777237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689777237 NPI number — ONAWAY AREA AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONAWAY AREA AMBULANCE SERVICE
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:
1689777237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 454
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONAWAY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49765-0454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-733-4166
Provider Business Mailing Address Fax Number:
989-733-8020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20734 INDUSTRIAL PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONAWAY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-733-4166
Provider Business Practice Location Address Fax Number:
989-733-8020
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLEARY
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
517-318-3756

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  711002 , 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: 3156865 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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