Healthcare Provider Details

I. General information

NPI: 1508617333
Provider Name (Legal Business Name): BEAVER ISLAND EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36155 E SIDE DR
BEAVER ISLAND MI
49782-5175
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 231-448-2578
  • Fax:
Mailing address:
  • Phone: 734-224-4474
  • Fax: 336-791-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KATHLEENA MARIE MASON
Title or Position: DIRECTOR
Credential:
Phone: 231-330-5582