Provider Demographics
NPI:1205186632
Name:INTEGRATED FIRST RESPONSE-GREAT LAKES
Entity Type:Organization
Organization Name:INTEGRATED FIRST RESPONSE-GREAT LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-366-3299
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-0512
Mailing Address - Country:US
Mailing Address - Phone:605-582-6096
Mailing Address - Fax:605-582-8983
Practice Address - Street 1:2260 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802
Practice Address - Country:US
Practice Address - Phone:855-437-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport