Provider Demographics
NPI:1497754048
Name:MAYVILLE AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MAYVILLE AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:989-843-6136
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:5802 LYNCH DRIVE
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744-0181
Mailing Address - Country:US
Mailing Address - Phone:989-843-6136
Mailing Address - Fax:989-843-5170
Practice Address - Street 1:5802 LYNCH DR
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-8640
Practice Address - Country:US
Practice Address - Phone:989-843-6136
Practice Address - Fax:989-843-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI791004146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9002290OtherHEALTHPLUS
MI0G90012OtherBLUE CROSS BLUE SHIELD
MI3004139Medicare ID - Type Unspecified
MI0G90012Medicare ID - Type Unspecified