Provider Demographics
NPI:1346384401
Name:ROCK COMMUNITY AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:ROCK COMMUNITY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-365-6905
Mailing Address - Street 1:828 SHERIDAN RD
Mailing Address - Street 2:P O BOX 415
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1531
Mailing Address - Country:US
Mailing Address - Phone:906-786-2051
Mailing Address - Fax:906-786-0080
Practice Address - Street 1:4042 EAST MAPLE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ROCK
Practice Address - State:MI
Practice Address - Zip Code:49880
Practice Address - Country:US
Practice Address - Phone:906-365-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2110083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2973730Medicaid
MI0B10003Medicare ID - Type UnspecifiedMEDICARE PROVIDER#