Provider Demographics
NPI:1225088222
Name:DVA AMBULANCE, INC.
Entity Type:Organization
Organization Name:DVA AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-288-3177
Mailing Address - Street 1:308 N. SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1237
Mailing Address - Country:US
Mailing Address - Phone:989-288-3177
Mailing Address - Fax:989-288-6770
Practice Address - Street 1:308 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1237
Practice Address - Country:US
Practice Address - Phone:989-288-3177
Practice Address - Fax:989-288-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI781002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0000200OtherGENESEE HEALTH PLAN
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MI3000499OtherHEALTH PLAN OF MICHIGAN
MI1000137OtherMCLAREN HEALTH PLAN
MI3000499OtherCOMMUNITY CHOICE
MI3000499OtherMIDWEST HEALTH PLAN
MI3000499OtherTOTAL HEALTH CARE
MI3000499OtherCAPE HEALTH PLAN
MI3000499OtherKALAMAZOO COUNTY HEALTH P
MI3000499OtherGREAT LAKES HEALTH PLAN
MI4528105OtherMID MICHIGAN HEALTH PLAN
MI590G80007OtherBLUE CROSS BLUE SHIELD MI
MI0000200OtherHEALTH PLUS OF MICHIGAN
MI1221240001OtherCHS THE WELLNESS PLAN
MI3000499Medicaid
MI1221240001OtherCHS THE WELLNESS PLAN
MI3000499OtherKALAMAZOO COUNTY HEALTH P