MEDICARE: OGEMAW COUNTY EMERGENCY MEDICAL SERVICES 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	651001	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
2	590F510370	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1578504882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGEMAW COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-0399
Country	:	US
Telephone Number	:	989-345-4503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2872 HANSEN RD
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9317
Country	:	US
Telephone Number	:	989-345-4503
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JUSTIN ROGERS
Credential	:
Telephone Number	:	989-387-1961

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/01/2023

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