Provider Demographics
NPI:1780688721
Name:SOUTHWESTERN MICHIGAN COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SOUTHWESTERN MICHIGAN COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SCRIBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-684-2170
Mailing Address - Street 1:2100 W CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-8701
Mailing Address - Country:US
Mailing Address - Phone:269-684-2170
Mailing Address - Fax:269-684-2152
Practice Address - Street 1:2100 W CHICAGO RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-8701
Practice Address - Country:US
Practice Address - Phone:269-684-2170
Practice Address - Fax:269-684-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111009341600000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3003946Medicaid
590A10023OtherBLUE CROSS
MI3003946Medicaid