Provider Demographics
NPI:1881686764
Name:LAPEER COUNTY EMS AUTHORITY
Entity Type:Organization
Organization Name:LAPEER COUNTY EMS AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GALLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-664-2927
Mailing Address - Street 1:3565 GENESEE RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2984
Mailing Address - Country:US
Mailing Address - Phone:810-664-2927
Mailing Address - Fax:810-664-3749
Practice Address - Street 1:3565 GENESEE RD
Practice Address - Street 2:ST 1
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2984
Practice Address - Country:US
Practice Address - Phone:810-664-2927
Practice Address - Fax:810-664-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI441002341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590D400030OtherBLUE CROSS BLUE SHIELD
MI184338370Medicaid
MI184338370Medicaid