MEDICARE: CLINTON AREA AMBULANCE SERVICE AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	191001	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00218396	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	590A910200	OTHER	MI	BCBSM
4	200000000500	OTHER		PHPMM

General Provider Information

NPI Number	:	1023046695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINTON AREA AMBULANCE SERVICE AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 203
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-0203
Country	:	US
Telephone Number	:	892-275-7139
Fax Number	:	989-224-7870

Provider Business Practice Location Address
First Line	:	1001 S OAKLAND ST
Second Line	:
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2305
Country	:	US
Telephone Number	:	517-227-5713
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LYNN CHARLES WEBER
Credential	:	EMTP IC
Telephone Number	:	989-227-5713

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/06/2021

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Directions to “CLINTON AREA AMBULANCE SERVICE AUTHORITY ” Practice Location

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