Provider Demographics
NPI:1326267006
Name:FIFE LAKE AREA AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:FIFE LAKE AREA AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOUTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-357-5442
Mailing Address - Street 1:P.O. BOX 216
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633
Mailing Address - Country:US
Mailing Address - Phone:231-879-4009
Mailing Address - Fax:231-879-3146
Practice Address - Street 1:134 MORGAN ST
Practice Address - Street 2:
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633
Practice Address - Country:US
Practice Address - Phone:231-879-4009
Practice Address - Fax:231-897-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590D010060OtherBCBS OF MICHIGAN
MI184605474Medicaid
MIP00208624OtherRAILROAD MEDICARE
MI590D010060OtherBCBS OF MICHIGAN