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General NPI Number Information
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NPI Number | 1366499527
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Entity Type | Organization
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Legal Business Name | LIFE EMS OF IONIA CO INC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 350 W WASHINGTON ST
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City | IONIA
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State | MI
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Zip | 48846-1543
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Country | US
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Telephone | 616-527-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 CEDAR ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1378
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Country | US
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Telephone | 616-458-0042
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Fax | 616-242-8825
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. MARK D MEIJER
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Credential |
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Telephone | 616-242-8805
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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 | 621008
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License Number State | MI
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