Provider Demographics
NPI:1922250018
Name:HURON VALLEY AMBULANCE INC
Entity Type:Organization
Organization Name:HURON VALLEY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-477-6262
Mailing Address - Street 1:1200 STATE CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1691
Mailing Address - Country:US
Mailing Address - Phone:734-971-4733
Mailing Address - Fax:734-477-6786
Practice Address - Street 1:1200 STATE CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1691
Practice Address - Country:US
Practice Address - Phone:734-971-4733
Practice Address - Fax:734-477-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8110062083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI183005225Medicaid
MI590H10020OtherBLUE CROSS BLUE SHIELD
MI0H10020Medicare PIN