Provider Demographics
NPI:1760699789
Name:COUNTY OF MISSAUKEE
Entity Type:Organization
Organization Name:COUNTY OF MISSAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-839-2198
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-0800
Mailing Address - Country:US
Mailing Address - Phone:231-335-7256
Mailing Address - Fax:231-839-2205
Practice Address - Street 1:404 FIRST STREET
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-0800
Practice Address - Country:US
Practice Address - Phone:231-839-6101
Practice Address - Fax:231-839-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590058323OtherRAILROAD MEDICARE
MI3000274Medicaid
MI0E70003OtherBLUE CROSS OF MICHIGAN
MI0E70003Medicare ID - Type Unspecified