Healthcare Provider Details

I. General information

NPI: 1063327302
Provider Name (Legal Business Name): 1ST. SOURCE NEMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N WALNUT ST # 1
LANSING MI
48933-1127
US

IV. Provider business mailing address

522 N WALNUT ST
LANSING MI
48933-1127
US

V. Phone/Fax

Practice location:
  • Phone: 517-755-8640
  • Fax:
Mailing address:
  • Phone: 517-755-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ULYSSES LAMONT ALLEN
Title or Position: OWNER
Credential:
Phone: 517-755-8640