Provider Demographics
NPI:1720137201
Name:NORTHERN BAY AMBULANCE AND RESCUE SERVICE OF MICHIGAN
Entity Type:Organization
Organization Name:NORTHERN BAY AMBULANCE AND RESCUE SERVICE OF MICHIGAN
Other - Org Name:NORTHERN BAY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-853-3682
Mailing Address - Street 1:PO BOX 2122
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-1122
Mailing Address - Country:US
Mailing Address - Phone:734-224-4474
Mailing Address - Fax:734-479-6319
Practice Address - Street 1:325 S. LIBBY ST
Practice Address - Street 2:
Practice Address - City:PINCONNING
Practice Address - State:MI
Practice Address - Zip Code:48650-8400
Practice Address - Country:US
Practice Address - Phone:989-879-2220
Practice Address - Fax:989-879-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI091002341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z90008OtherBCBSM
MI3002949Medicaid
MI3002949Medicaid