Provider Demographics
NPI:1851343297
Name:MARCELLUS AREA EMERGENCY SERVICES ASSOCIATION
Entity Type:Organization
Organization Name:MARCELLUS AREA EMERGENCY SERVICES ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-646-9900
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-479-6300
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:177 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:MI
Practice Address - Zip Code:49067-8523
Practice Address - Country:US
Practice Address - Phone:269-646-9900
Practice Address - Fax:269-646-8052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1410043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3116476Medicaid
MI590009181OtherRR MEDICARE
MI3116476Medicaid