Provider Demographics
NPI:1154355147
Name:LAINGSBURG SCIOTA WOODHULL EMERGENCY SERVICES AUTHORITY
Entity type:Organization
Organization Name:LAINGSBURG SCIOTA WOODHULL EMERGENCY SERVICES AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:POLICE CHIEF/FIRE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEKORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-651-5355
Mailing Address - Street 1:7425 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9759
Mailing Address - Country:US
Mailing Address - Phone:517-651-2638
Mailing Address - Fax:517-651-6292
Practice Address - Street 1:7425 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:LAINGSBURG
Practice Address - State:MI
Practice Address - Zip Code:48848-9759
Practice Address - Country:US
Practice Address - Phone:517-651-2638
Practice Address - Fax:517-651-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI781009341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI590G200030OtherBCBSM NUMBER
MI4453087Medicaid