Healthcare Provider Details

I. General information

NPI: 1649228123
Provider Name (Legal Business Name): BEACON AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E CLOVERLAND DR
IRONWOOD MI
49938-1227
US

IV. Provider business mailing address

300 VILLA DR
HURLEY WI
54534-1523
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-3434
  • Fax:
Mailing address:
  • Phone: 715-561-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number6000577
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number991001
License Number StateMI

VIII. Authorized Official

Name: MR. JOHN KUTZ
Title or Position: OWNER
Credential:
Phone: 715-561-3200