Provider Demographics
NPI:1003837014
Name:COLDSPRINGS-EXCELSIOR VOUNTEER FIRE & RESCUE DEPT
Entity Type:Organization
Organization Name:COLDSPRINGS-EXCELSIOR VOUNTEER FIRE & RESCUE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-258-2107
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:
Practice Address - Street 1:6565 COUNTY ROAD 612 NE
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-9530
Practice Address - Country:US
Practice Address - Phone:231-258-2107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI401002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI184753931Medicaid
MI0P20940Medicare PIN