Provider Demographics
NPI:1023046695
Name:CLINTON AREA AMBULANCE SERVICE AUTHORITY
Entity Type:Organization
Organization Name:CLINTON AREA AMBULANCE SERVICE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP IC
Authorized Official - Phone:989-227-5713
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-0203
Mailing Address - Country:US
Mailing Address - Phone:892-275-7139
Mailing Address - Fax:989-224-7870
Practice Address - Street 1:1001 S OAKLAND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2305
Practice Address - Country:US
Practice Address - Phone:517-227-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1910013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4737624Medicaid
P00218396OtherRAILROAD MEDICARE
MI590A910200OtherBCBSM
200000000500OtherPHPMM