Provider Demographics
NPI:1619929858
Name:KINGSLEY AREA EMERGENCY AMBULANCE SERVICE INCORPORATED
Entity Type:Organization
Organization Name:KINGSLEY AREA EMERGENCY AMBULANCE SERVICE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARYTREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HULETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-263-4421
Mailing Address - Street 1:2266 E M 113
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9370
Mailing Address - Country:US
Mailing Address - Phone:231-263-4421
Mailing Address - Fax:231-263-4422
Practice Address - Street 1:2266 E M 113
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9370
Practice Address - Country:US
Practice Address - Phone:231-263-4421
Practice Address - Fax:231-263-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2810063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590B800090OtherBCBSM
MI183035888Medicaid
MI183035888Medicaid