Provider Demographics
NPI:1427046481
Name:LESLIE AREA AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:LESLIE AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER,BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-589-9141
Mailing Address - Street 1:210 E BELLEVUE ST
Mailing Address - Street 2:PO BOX 461
Mailing Address - City:LESLIE
Mailing Address - State:MI
Mailing Address - Zip Code:49251-9373
Mailing Address - Country:US
Mailing Address - Phone:517-589-9141
Mailing Address - Fax:517-589-9819
Practice Address - Street 1:210 E BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:MI
Practice Address - Zip Code:49251-9373
Practice Address - Country:US
Practice Address - Phone:517-589-9141
Practice Address - Fax:517-589-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3310053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC30020OtherBLUECROSSBLUESHIELD
MI81-09470OtherPHYSICIANS HEALTH PLAN
MIOC30020OtherBLUECROSSBLUESHIELD