Healthcare Provider Details

I. General information

NPI: 1649258211
Provider Name (Legal Business Name): LAKEWOOD COMMUNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W BROADWAY ST
WOODLAND MI
48897-9798
US

IV. Provider business mailing address

1701 LAKE LANSING RD SUITE 100
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 269-367-4453
  • Fax: 269-367-4453
Mailing address:
  • Phone: 517-485-0001
  • Fax: 517-485-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number341007
License Number StateMI

VIII. Authorized Official

Name: JIM ROBERTSON
Title or Position: DIRECTOR
Credential:
Phone: 269-367-4768