MEDICARE: SOUTHEAST PUBLIC SAFETY 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	341600000X	Ambulance	141006	MI

General Provider Information

NPI Number	:	1245265818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST PUBLIC SAFETY AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 409
Second Line	:
City	:	UNION
State	:	MI
Zip	:	49130-0409
Country	:	US
Telephone Number	:	269-641-7100
Fax Number	:	269-641-5582

Provider Business Practice Location Address
First Line	:	69401 BALDWIN PRAIRIE RD N
Second Line	:
City	:	UNION
State	:	MI
Zip	:	49130-9601
Country	:	US
Telephone Number	:	269-641-7100
Fax Number	:	269-641-5582

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MICHAEL W. HOLDEMAN
Credential	:
Telephone Number	:	269-641-7100

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTHEAST PUBLIC SAFETY AUTHORITY ” Practice Location

Language	Start Address	Practice Location

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