WHITE LAKE AMBULANCE SERVICE NPI 1225033855

NPI Information

  • NPI: 1225033855
  • Provider Name: WHITE LAKE AMBULANCE SERVICE
  • Classification: Ambulance - 3416L0300X
  • Specialization: Land Transport
  • Entity Type: Organization
  • CLIA Number: 23D1042026
  • Address: 5085 WILCOX ST
    MONTAGUE, MI
    ZIP 49437
  • Phone: (231) 894-4306

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NPI Details

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 following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Ground mileage, per statute mile (HCPCS:A0425)
  • Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) (HCPCS:A0427)
  • Ambulance service, basic life support, emergency transport (bls-emergency) (HCPCS:A0429)

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
13416L0300XAmbulanceLand Transport611002MICHIGANYes

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 Other Provider Identifier Issuer
10N15360MEDICARE ID-TYPE UNSPECIFIEDMICHIGAN
24217295MEDICAIDMICHIGAN
30N15360MEDICARE PINMICHIGAN

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: 3/30/2025

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