Provider Demographics
NPI:1215020441
Name:PATRIOT AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:PATRIOT AMBULANCE SERVICE, INC.
Other - Org Name:PATRIOT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:YORKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-742-5391
Mailing Address - Street 1:4225 MILLER ROAD
Mailing Address - Street 2:#233
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-742-5391
Mailing Address - Fax:810-742-5366
Practice Address - Street 1:4225 MILLER ROAD
Practice Address - Street 2:#233
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-742-5391
Practice Address - Fax:810-742-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2510403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4600594Medicaid
MI590B512330OtherBLUE CROSS BLUE SHIELD
MI0997666OtherHEALTH PLUS OF MI
MI4600594Medicaid