Provider Demographics
NPI:1114004892
Name:CASTLETON-MAPLE GROVE-NASHVILLE AMBULANCE
Entity Type:Organization
Organization Name:CASTLETON-MAPLE GROVE-NASHVILLE AMBULANCE
Other - Org Name:CMGNA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-852-9385
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49073-0587
Mailing Address - Country:US
Mailing Address - Phone:517-852-9385
Mailing Address - Fax:517-852-0281
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:MI
Practice Address - Zip Code:49073-0587
Practice Address - Country:US
Practice Address - Phone:517-852-9385
Practice Address - Fax:517-852-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI081002341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183001683Medicaid
MI183156874Medicaid
MI590Z800010OtherBCBSM
MI183156874Medicaid
MI590Z800010OtherBCBSM