Provider Demographics
NPI:1013952795
Name:GRAND LEDGE AREA EMERGENCY SERVICES
Entity Type:Organization
Organization Name:GRAND LEDGE AREA EMERGENCY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-627-1157
Mailing Address - Street 1:2869 JOLLY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3670
Mailing Address - Country:US
Mailing Address - Phone:517-908-3980
Mailing Address - Fax:517-908-3981
Practice Address - Street 1:500 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1620
Practice Address - Country:US
Practice Address - Phone:517-627-1157
Practice Address - Fax:517-627-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2310213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590B310590OtherBLUE CROSS BLUE SHIELD
MI184720743Medicaid
P00218393OtherRAILROAD MEDICARE
MI200000003600OtherPHP
P00218393OtherRAILROAD MEDICARE