Provider Demographics
NPI:1841235264
Name:ADDISON FIRE BOARD
Entity Type:Organization
Organization Name:ADDISON FIRE BOARD
Other - Org Name:ADDISON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WEYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-547-6776
Mailing Address - Street 1:319 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:MI
Mailing Address - Zip Code:49220-9780
Mailing Address - Country:US
Mailing Address - Phone:517-547-6776
Mailing Address - Fax:517-547-4179
Practice Address - Street 1:319 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:MI
Practice Address - Zip Code:49220-9780
Practice Address - Country:US
Practice Address - Phone:517-547-6776
Practice Address - Fax:517-547-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI087969341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2768739Medicaid
MI0N92870Medicare ID - Type Unspecified