WHITE LAKE AMBULANCE SERVICE NPI 1225033855

NPI Information

NPI: 1225033855
Provider Name: WHITE LAKE AMBULANCE SERVICE
Classification: Ambulance - 3416L0300X
Entity Type: Organization

Specialization: Land Transport

CLIA Number: 23D1042026

Address:
5085 WILCOX ST
MONTAGUE, MI
ZIP 49437
Phone: (231) 894-4306
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WHITE LAKE AMBULANCE SERVICE is a land transport ambulance in Montague, MI. WHITE LAKE AMBULANCE SERVICE NPI is 1225033855. The provider is registered as an organization entity type.

The provider's business location address is:

5085 WILCOX ST
MONTAGUE, MI
ZIP 49437-558
Phone: (231) 894-4306
Fax: (231) 893-0249

The provider's authorized official is Jonathon Degen .
The authorized official title is Director and has the following contact phone number (231) 894-4306.

The CLIA number assigned to this NPI record is 23D1042026 - ambulance with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/20/2005 and was last updated on 6/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	3416L0300X	Ambulance	Land Transport	611002	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	0N15360	MEDICARE ID-TYPE UNSPECIFIED	MICHIGAN
2	4217295	MEDICAID	MICHIGAN
3	0N15360	MEDICARE PIN	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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