Provider Demographics
NPI:1689730939
Name:UNIVERSAL-MACOMB AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:UNIVERSAL-MACOMB AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MCLOCKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-939-4350
Mailing Address - Street 1:37583 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4124
Mailing Address - Country:US
Mailing Address - Phone:586-939-4350
Mailing Address - Fax:586-939-4445
Practice Address - Street 1:37583 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4124
Practice Address - Country:US
Practice Address - Phone:586-939-4350
Practice Address - Fax:586-939-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5010133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00022OtherHEALTH ALLIANCE PLAN
MI0E000229OtherBLUE CROSS BLUE SHEILD
MI0E00022OtherHEALTH ALLIANCE PLAN