Provider Demographics
NPI:1508617333
Name:BEAVER ISLAND EMS
Entity Type:Organization
Organization Name:BEAVER ISLAND EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-330-5582
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-224-4474
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:36155 E SIDE DR
Practice Address - Street 2:
Practice Address - City:BEAVER ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49782-5175
Practice Address - Country:US
Practice Address - Phone:231-448-2578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAVER ISLAND EMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport