Healthcare Provider Details

I. General information

NPI: 1881686764
Provider Name (Legal Business Name): LAPEER COUNTY EMS AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 GENESEE RD ST 1
LAPEER MI
48446-2984
US

IV. Provider business mailing address

3565 GENESEE RD SUITE # 1
LAPEER MI
48446-2984
US

V. Phone/Fax

Practice location:
  • Phone: 810-664-2927
  • Fax: 810-664-3749
Mailing address:
  • Phone: 810-664-2927
  • Fax: 810-664-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number441002
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number441002
License Number StateMI

VIII. Authorized Official

Name: MR. GALLAND BURNHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 810-664-2927