=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316982465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED RESCUE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2006
-----------------------------------------------------
Last Update Date | 12/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 W BEECH ST
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-539-6331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 577 229 E BEECH
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-539-6331
-----------------------------------------------------
Fax | 989-539-9121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. LARRY KEITH REED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-539-6331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 181002
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------