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General NPI Number Information
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NPI Number | 1801831375
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Entity Type | Organization
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Legal Business Name | ONTWA JEFFERSON MASON MILTON CALVIN TNSHPS & VILLAGE OF EDWARDSBURG
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 26273 E SHORE DR
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City | EDWARDSBURG
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State | MI
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Zip | 49112-8453
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Country | US
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Telephone | 269-663-2347
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Fax | 269-663-0072
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Provider Business Mailing Address
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Address Line | PO BOX 384
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City | EDWARDSBURG
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State | MI
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Zip | 49112-0384
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Country | US
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Telephone | 269-663-8022
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Fax | 269-663-0130
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DENNIS CLOSSON
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Credential | PARAMEDIC
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Telephone | 269-663-8022
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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 | 141003
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License Number State | MI
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