Healthcare Provider Details

I. General information

NPI: 1295020139
Provider Name (Legal Business Name): EAST GRAND LAKE VOLUNTEER FIRE DEPARTMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8959 E GRAND LAKE RD
PRESQUE ISLE MI
49777-8633
US

IV. Provider business mailing address

PO BOX 9
PRESQUE ISLE MI
49777-0009
US

V. Phone/Fax

Practice location:
  • Phone: 989-595-2412
  • Fax:
Mailing address:
  • Phone: 989-595-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number711001
License Number StateMI

VIII. Authorized Official

Name: MICHELE MOORE
Title or Position: BILLING MANAGER
Credential:
Phone: 517-318-3732