MEDICARE: FIFE LAKE AREA EMERGENCY RESCUE 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	281002	MI

General Provider Information

NPI Number	:	1174815385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIFE LAKE AREA EMERGENCY RESCUE AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 216
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-0216
Country	:	US
Telephone Number	:	231-879-3146
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 MORGAN ST
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-9068
Country	:	US
Telephone Number	:	231-879-3146
Fax Number	:

Authorized Official
Title or Position	:	TOWNSHIP CLERK
Name	:	MISS JUDY HOUTS
Credential	:
Telephone Number	:	231-879-3963

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/05/2011

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Directions to “FIFE LAKE AREA EMERGENCY RESCUE AUTHORITY ” Practice Location

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