Provider Demographics
NPI:1407847346
Name:EMERGENCY MED STAT LLC
Entity Type:Organization
Organization Name:EMERGENCY MED STAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-230-1208
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-0497
Mailing Address - Country:US
Mailing Address - Phone:810-230-1208
Mailing Address - Fax:810-230-1213
Practice Address - Street 1:G3538 FLUSHING RD
Practice Address - Street 2:SUITE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4255
Practice Address - Country:US
Practice Address - Phone:810-230-1208
Practice Address - Fax:810-230-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2510413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4726255Medicaid
MIOP10300Medicare ID - Type Unspecified