MEDICARE: MICHIGAN AREA AMBULANCE SERVICE, 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	146N00000X	Basic Emergency Medical Technician	085	ND
2	341600000X	Ambulance	85	ND

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	:	1962614461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN AREA AMBULANCE SERVICE, INC

Provider Business Mailing Address
First Line	:	PO BOX 17
Second Line	:	117 BROADWAY
City	:	MICHIGAN
State	:	ND
Zip	:	58259-0017
Country	:	US
Telephone Number	:	701-259-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 BROADWAY
Second Line	:
City	:	MICHIGAN
State	:	ND
Zip	:	58259-0017
Country	:	US
Telephone Number	:	701-259-2299
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/DIRECTOR
Name	:	JASON M FLOM
Credential	:
Telephone Number	:	701-259-2299

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	12/19/2017

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