Provider Demographics
NPI:1811060965
Name:STOCKBRIDGE AREA EMERGENCY SERVICES AUTHORITY
Entity type:Organization
Organization Name:STOCKBRIDGE AREA EMERGENCY SERVICES AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-851-7943
Mailing Address - Street 1:P.O. BOX 728
Mailing Address - Street 2:125 S. CENTER ST
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285
Mailing Address - Country:US
Mailing Address - Phone:517-851-7943
Mailing Address - Fax:517-851-7645
Practice Address - Street 1:1009 S. CLINTON
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285
Practice Address - Country:US
Practice Address - Phone:517-851-7943
Practice Address - Fax:517-851-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C30014OtherBLUE CROSS BLUE SHIELD
MI1777644Medicaid
MI1777644Medicaid