Provider Demographics
NPI:1558453845
Name:COUNTY OF MECOSTA
Entity Type:Organization
Organization Name:COUNTY OF MECOSTA
Other - Org Name:MECOSTA COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-796-2626
Mailing Address - Street 1:14485 NORTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2368
Mailing Address - Country:US
Mailing Address - Phone:231-796-2626
Mailing Address - Fax:231-796-0231
Practice Address - Street 1:14485 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2368
Practice Address - Country:US
Practice Address - Phone:231-796-2626
Practice Address - Fax:231-796-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI541001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183000480Medicaid
MI0E40001OtherBLUE CROSS BLUE SHIELD
MI183000480Medicaid