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General NPI Number Information
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NPI Number | 1902076581
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Entity Type | Organization
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Legal Business Name | GREAT LAKES MEDICAL TRANSPORT
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 2600 TONAWANDA LAKE RD
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City | GRAWN
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State | MI
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Zip | 49637-9616
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Country | US
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Telephone | 989-422-5629
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Fax |
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Provider Business Mailing Address
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Address Line | 2831 S LOXLEY RD
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9246
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Country | US
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Telephone | 989-422-5625
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. TAMMY ANN SAUVE
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Credential |
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Telephone | 989-422-5625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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