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General NPI Number Information
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NPI Number | 1336130848
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MED TEAM
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 965 FORK ST
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City | MUSKEGON
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State | MI
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Zip | 49442-3257
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Country | US
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Telephone | 231-720-1804
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Fax | 231-720-1805
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Provider Business Mailing Address
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Address Line | 965 FORK ST
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City | MUSKEGON
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State | MI
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Zip | 49442-3257
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Country | US
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Telephone | 231-720-1804
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Fax | 231-720-1805
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Authorized Official
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Title or Position | DIRECTOR OF EMS OPERATIONS
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Name | CHAD CROOK
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Credential |
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Telephone | 231-672-7172
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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 | 611004
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License Number State | MI
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