MEDICARE: UNIVERSAL-MACOMB AMBULANCE SERVICE, INC.

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	501013	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0E00022	OTHER	MI	HEALTH ALLIANCE PLAN
2	0E000229	OTHER	MI	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1689730939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL-MACOMB AMBULANCE SERVICE, INC.

Provider Business Mailing Address
First Line	:	37583 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4124
Country	:	US
Telephone Number	:	586-939-4350
Fax Number	:	586-939-4445

Provider Business Practice Location Address
First Line	:	37583 MOUND RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4124
Country	:	US
Telephone Number	:	586-939-4350
Fax Number	:	586-939-4445

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DONALD KENT MCLOCKLIN
Credential	:
Telephone Number	:	586-939-4350

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/22/2020

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