MEDICARE: CLINTON AREA AMBULANCE SERVICE AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	191001	MI

General Provider Information

NPI Number	:	1437424066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON AREA AMBULANCE SERVICE AUTHORITY

Provider Business Mailing Address
First Line	:	1001 S OAKLAND ST
Second Line	:	PO BOX 203
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2305
Country	:	US
Telephone Number	:	989-227-5713
Fax Number	:	989-224-7870

Provider Business Practice Location Address
First Line	:	1001 S OAKLAND ST
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2305
Country	:	US
Telephone Number	:	989-227-5713
Fax Number	:	989-224-7870

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. LYNN CHARLES WEBER
Credential	:
Telephone Number	:	989-227-5713

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

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