Provider Demographics
NPI:1578504882
Name:OGEMAW COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY
Entity Type:Organization
Organization Name:OGEMAW COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY
Other - Org Name:OGEMAW COUNTY EMS AUTHORITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-387-1961
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-0399
Mailing Address - Country:US
Mailing Address - Phone:989-345-4503
Mailing Address - Fax:
Practice Address - Street 1:2872 HANSEN RD
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9317
Practice Address - Country:US
Practice Address - Phone:989-345-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6510013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4893899Medicaid
MI590F510370OtherBCBSM
MIOP33560Medicare PIN