MEDICARE: LIFE EMS OF IONIA CO 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	3416L0300X	Land Ambulance	621008	MI

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

General Provider Information

NPI Number	:	1366499527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE EMS OF IONIA CO INC

Provider Business Mailing Address
First Line	:	1275 CEDAR ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-1378
Country	:	US
Telephone Number	:	616-458-0042
Fax Number	:	616-242-8825

Provider Business Practice Location Address
First Line	:	350 W WASHINGTON ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-1543
Country	:	US
Telephone Number	:	616-527-9125
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. MARK D MEIJER
Credential	:
Telephone Number	:	616-242-8805

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	05/19/2009

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Directions to “LIFE EMS OF IONIA CO INC ” Practice Location

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