Provider Demographics
NPI:1306848783
Name:HOUGHTON LAKE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:HOUGHTON LAKE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLESSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-422-3312
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-0746
Mailing Address - Country:US
Mailing Address - Phone:989-422-3312
Mailing Address - Fax:989-422-6145
Practice Address - Street 1:9166 W LAKE CITY RD.
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629
Practice Address - Country:US
Practice Address - Phone:989-422-3312
Practice Address - Fax:989-422-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI721010341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMC0G20006Medicare ID - Type Unspecified