Provider Demographics
NPI:1811084577
Name:EASTERN HURON AMBULANCE SERVICE
Entity type:Organization
Organization Name:EASTERN HURON AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/IC
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:989-479-0910
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-0028
Mailing Address - Country:US
Mailing Address - Phone:989-479-0910
Mailing Address - Fax:989-479-0911
Practice Address - Street 1:108 NELSON ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1168
Practice Address - Country:US
Practice Address - Phone:989-479-0910
Practice Address - Fax:989-479-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3210023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590C20016OtherBLUE CROSS BLUE SHIELD
MI20100AOtherHEALTH ALLIANCE
MI3004658Medicaid
MIP25162FOtherBLUE CARE NETWORK
MI3004658Medicaid