Provider Demographics
NPI:1689674962
Name:C M AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:C M AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-686-7600
Mailing Address - Street 1:3370 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1374
Mailing Address - Country:US
Mailing Address - Phone:810-686-7600
Mailing Address - Fax:810-686-6017
Practice Address - Street 1:3370 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1374
Practice Address - Country:US
Practice Address - Phone:810-686-7600
Practice Address - Fax:810-686-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590B500210OtherBLUECROSS BLUESHIELD
MI3000031Medicaid
MI3000031Medicaid