Provider Demographics
NPI:1245265818
Name:SOUTHEAST PUBLIC SAFETY AUTHORITY
Entity type:Organization
Organization Name:SOUTHEAST PUBLIC SAFETY AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-641-7100
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MI
Mailing Address - Zip Code:49130-0409
Mailing Address - Country:US
Mailing Address - Phone:269-641-7100
Mailing Address - Fax:269-641-5582
Practice Address - Street 1:69401 BALDWIN PRAIRIE RD N
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MI
Practice Address - Zip Code:49130-9601
Practice Address - Country:US
Practice Address - Phone:269-641-7100
Practice Address - Fax:269-641-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P20850Medicare ID - Type UnspecifiedMEDICARE