Provider Demographics
NPI:1649854266
Name:LAKE CHARLEVOIX EMERGENCY MEDICAL SERVICES AUTHORITY
Entity type:Organization
Organization Name:LAKE CHARLEVOIX EMERGENCY MEDICAL SERVICES AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:231-547-7172
Mailing Address - Street 1:9251 MAJOR DOUGLAS SLOAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9441
Mailing Address - Country:US
Mailing Address - Phone:231-547-7172
Mailing Address - Fax:231-557-3266
Practice Address - Street 1:9251 MAJOR DOUGLAS SLOAN RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9441
Practice Address - Country:US
Practice Address - Phone:231-547-7172
Practice Address - Fax:231-557-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance