Healthcare Provider Details

I. General information

NPI: 1780688721
Provider Name (Legal Business Name): SOUTHWESTERN MICHIGAN COMMUNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CHICAGO RD
NILES MI
49120-8701
US

IV. Provider business mailing address

2100 W CHICAGO RD
NILES MI
49120-8701
US

V. Phone/Fax

Practice location:
  • Phone: 269-684-2170
  • Fax: 269-684-2152
Mailing address:
  • Phone: 269-684-2170
  • Fax: 269-684-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number111009
License Number StateMI

VIII. Authorized Official

Name: JAMES BRIAN SCRIBNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 269-684-2170