Provider Demographics
NPI:1205832656
Name:OTSEGO COUNTY AMBULANCE CORPS, INC.
Entity Type:Organization
Organization Name:OTSEGO COUNTY AMBULANCE CORPS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-732-9085
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:100 MCLOUTH
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-0642
Mailing Address - Country:US
Mailing Address - Phone:989-732-9085
Mailing Address - Fax:989-732-9497
Practice Address - Street 1:100 MCLOUTH RD
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9339
Practice Address - Country:US
Practice Address - Phone:989-732-9085
Practice Address - Fax:989-732-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6910013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF90003Medicare ID - Type Unspecified