MEDICARE: EAST GRAND LAKE VOLUNTEER FIRE DEPARTMENT INC

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
2	341600000X	Ambulance	711001	MI

General Provider Information

NPI Number	:	1295020139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST GRAND LAKE VOLUNTEER FIRE DEPARTMENT INC

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-0009
Country	:	US
Telephone Number	:	989-595-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	8959 E GRAND LAKE RD
Second Line	:
City	:	PRESQUE ISLE
State	:	MI
Zip	:	49777-8633
Country	:	US
Telephone Number	:	989-595-2412
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MICHELE MOORE
Credential	:
Telephone Number	:	517-318-3732

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	12/03/2024

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