Provider Demographics
NPI:1063591055
Name:MESICK RESCUE SQUAD INC.
Entity type:Organization
Organization Name:MESICK RESCUE SQUAD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-885-1498
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668-0399
Mailing Address - Country:US
Mailing Address - Phone:231-885-1498
Mailing Address - Fax:
Practice Address - Street 1:108 S WALTER ST
Practice Address - Street 2:
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668
Practice Address - Country:US
Practice Address - Phone:231-885-1498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8310013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4365458Medicaid
MI590H30006OtherBLUE CROSS BLUE SHIELD
MI590H30006OtherBLUE CROSS BLUE SHIELD