Provider Demographics
NPI:1689619058
Name:BYRON AREA AMBULANCE SERVICE,INC
Entity Type:Organization
Organization Name:BYRON AREA AMBULANCE SERVICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-266-5220
Mailing Address - Street 1:210 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MI
Mailing Address - Zip Code:48418-9570
Mailing Address - Country:US
Mailing Address - Phone:810-266-5220
Mailing Address - Fax:810-266-5221
Practice Address - Street 1:210 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MI
Practice Address - Zip Code:48418-9570
Practice Address - Country:US
Practice Address - Phone:810-266-5220
Practice Address - Fax:810-266-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI781001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3003768Medicaid
MI0G80015Medicare ID - Type Unspecified