Provider Demographics
NPI:1417929746
Name:STOCKBRIDGE AREA AMBULANCE, INC.
Entity type:Organization
Organization Name:STOCKBRIDGE AREA AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-851-7943
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285-0336
Mailing Address - Country:US
Mailing Address - Phone:517-851-7943
Mailing Address - Fax:517-851-7645
Practice Address - Street 1:125 S. CENTER ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285-0336
Practice Address - Country:US
Practice Address - Phone:517-851-7943
Practice Address - Fax:517-851-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI331008261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1004630OtherMCLAREN HEALTH ADVANTAGE
MIP500126OtherCARE CHOICES
MI0C30014OtherBLUE CROSS
MI1004630OtherJACKSON HEALTH PLAN
MI1004630OtherMCLAREN HEALTH PLAN
MI1777644Medicaid
MI1777644Medicaid
MIP500126OtherCARE CHOICES