Healthcare Provider Details

I. General information

NPI: 1801831375
Provider Name (Legal Business Name): ONTWA JEFFERSON MASON MILTON CALVIN TNSHPS & VILLAGE OF EDWARDSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26273 E SHORE DR
EDWARDSBURG MI
49112-8453
US

IV. Provider business mailing address

PO BOX 384
EDWARDSBURG MI
49112-0384
US

V. Phone/Fax

Practice location:
  • Phone: 269-663-2347
  • Fax: 269-663-0072
Mailing address:
  • Phone: 269-663-8022
  • Fax: 269-663-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number141003
License Number StateMI

VIII. Authorized Official

Name: DENNIS CLOSSON
Title or Position: ADMINISTRATOR
Credential: PARAMEDIC
Phone: 269-663-8022