Provider Demographics
NPI:1104013077
Name:CORUNNA AREA AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:CORUNNA AREA AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATTHIES
Authorized Official - Suffix:
Authorized Official - Credentials:CCEMT-P I/C
Authorized Official - Phone:989-743-3050
Mailing Address - Street 1:PO BOX 632964
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 N SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1040
Practice Address - Country:US
Practice Address - Phone:989-743-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0883443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3003839Medicaid
MI200000008550OtherPHPMM
590045289OtherRAILROAD MEDICARE
MI590G800160OtherBCBSM
MI590G800160OtherBCBSM