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General NPI Number Information
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NPI Number | 1649228123
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Entity Type | Organization
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Legal Business Name | BEACON AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 101 E CLOVERLAND DR
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City | IRONWOOD
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State | MI
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Zip | 49938-1227
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Country | US
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Telephone | 906-932-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 300 VILLA DR
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City | HURLEY
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State | WI
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Zip | 54534-1523
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Country | US
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Telephone | 715-561-3200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN KUTZ
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Credential |
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Telephone | 715-561-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 6000577
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 991001
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License Number State | MI
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