=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851343297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARCELLUS AREA EMERGENCY SERVICES ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 E MAIN ST
-----------------------------------------------------
City | MARCELLUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49067-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-646-9900
-----------------------------------------------------
Fax | 269-646-8052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 E MAIN ST
-----------------------------------------------------
City | MARCELLUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49067-5102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-646-9900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULANCE DIRECTOR
-----------------------------------------------------
Name | MR. ROBERT OLSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-646-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 141004
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------