MEDICARE: COUNTY OF IOSCO

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	341600000X	Ambulance	35-1003	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590001430	OTHER	MI	PALMETTO GBA

General Provider Information

NPI Number	:	1912935651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF IOSCO

Provider Business Mailing Address
First Line	:	1808 E US 23
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-9315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 E US 23
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-9315
Country	:	US
Telephone Number	:	989-362-5534
Fax Number	:	989-362-5059

Authorized Official
Title or Position	:	COUNTY CONTROLLER/FINANCE DIRECTOR
Name	:	JAMIE CARRUTHERS-SOBOLESKI
Credential	:
Telephone Number	:	989-984-1000

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/12/2024

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Directions to “COUNTY OF IOSCO ” Practice Location

Language	Start Address	Practice Location

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