Provider Demographics
NPI:1366499170
Name:GREATER IRON COUNTY EMS, INC.
Entity Type:Organization
Organization Name:GREATER IRON COUNTY EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-265-0436
Mailing Address - Street 1:828 SHERIDAN RD
Mailing Address - Street 2:
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 1:1400 W ICE LAKE RD
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-9526
Practice Address - Country:US
Practice Address - Phone:906-265-0436
Practice Address - Fax:906-265-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3610013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590C60001OtherBCBS PROVIDER NUMBER
WI81932900Medicaid
MI4156350Medicaid
MI4156350Medicaid
WI81932900Medicaid