Provider Demographics
NPI:1962614461
Name:MICHIGAN AREA AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:MICHIGAN AREA AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-259-2299
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:117 BROADWAY
Mailing Address - City:MICHIGAN
Mailing Address - State:ND
Mailing Address - Zip Code:58259-0017
Mailing Address - Country:US
Mailing Address - Phone:701-259-2299
Mailing Address - Fax:
Practice Address - Street 1:117 BROADWAY
Practice Address - Street 2:
Practice Address - City:MICHIGAN
Practice Address - State:ND
Practice Address - Zip Code:58259-0017
Practice Address - Country:US
Practice Address - Phone:701-259-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND085146N00000X
ND85341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND052971Medicaid
N7122Medicare UPIN
ND052971Medicaid