Provider Demographics
NPI:1972788172
Name:SDP GROUP INC.
Entity Type:Organization
Organization Name:SDP GROUP INC.
Other - Org Name:MEDIC ONE AMBULANCE SERVICE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-946-4008
Mailing Address - Street 1:28111 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-2829
Mailing Address - Country:US
Mailing Address - Phone:734-946-4008
Mailing Address - Fax:734-946-4872
Practice Address - Street 1:28111 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2829
Practice Address - Country:US
Practice Address - Phone:734-946-4008
Practice Address - Fax:734-946-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821055341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1975810Medicaid
MI1975810Medicaid