Provider Demographics
NPI:1316031552
Name:CITY OF BOYNE
Entity Type:Organization
Organization Name:CITY OF BOYNE
Other - Org Name:BOYNE CITY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-582-9535
Mailing Address - Street 1:PO BOX 18246
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-8246
Mailing Address - Country:US
Mailing Address - Phone:517-318-3756
Mailing Address - Fax:
Practice Address - Street 1:319 N LAKE ST
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-2109
Practice Address - Country:US
Practice Address - Phone:231-582-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI151001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183001128Medicaid
MI183001128Medicaid