MEDICARE: COMMUNITY EMERGENCY SERVICE

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	111003	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619932415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY EMERGENCY SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 1563
Second Line	:	635 E. NAPIER AVE.
City	:	BENTON HARBOR
State	:	MI
Zip	:	49023-1563
Country	:	US
Telephone Number	:	269-925-2144
Fax Number	:	269-926-1139

Provider Business Practice Location Address
First Line	:	635 E NAPIER AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-5813
Country	:	US
Telephone Number	:	269-925-2144
Fax Number	:	269-926-1139

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JACK FISHER JR.
Credential	:
Telephone Number	:	269-925-2144

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/22/2020

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Directions to “COMMUNITY EMERGENCY SERVICE ” Practice Location

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