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General NPI Number Information
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NPI Number | 1063591055
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Entity Type | Organization
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Legal Business Name | MESICK RESCUE SQUAD INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 108 S WALTER ST
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City | MESICK
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State | MI
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Zip | 49668
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Country | US
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Telephone | 231-885-1498
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 399
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City | MESICK
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State | MI
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Zip | 49668-0399
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Country | US
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Telephone | 231-885-1498
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALLEN SHERBURNE
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Credential |
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Telephone | 231-885-1498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 831001
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License Number State | MI
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