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General NPI Number Information
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NPI Number | 1104013077
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Entity Type | Organization
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Legal Business Name | CORUNNA AREA AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 610 N SHIAWASSEE ST
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City | CORUNNA
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State | MI
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Zip | 48817-1040
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Country | US
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Telephone | 989-743-3050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 632964
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City | CINCINNATI
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State | OH
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Zip | 45263-2964
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | BRIAN W MATTHIES
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Credential | CCEMT-P I/C
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Telephone | 989-743-3050
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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 | 088344
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License Number State | MI
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