Healthcare Provider Details

I. General information

NPI: 1649854266
Provider Name (Legal Business Name): LAKE CHARLEVOIX EMERGENCY MEDICAL SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9251 MAJOR DOUGLAS SLOAN RD
CHARLEVOIX MI
49720-9441
US

IV. Provider business mailing address

PO BOX 747
WHEELING IL
60090-0747
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-7172
  • Fax: 231-557-3266
Mailing address:
  • Phone: 734-224-4474
  • Fax: 336-791-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JESSE L SILVA
Title or Position: ADMINISTRATION
Credential: DIRECTOR
Phone: 231-547-7172