Provider Demographics
NPI:1992703656
Name:BAY AMBULANCE, INC
Entity type:Organization
Organization Name:BAY AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADAGA
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:906-353-6196
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-0001
Mailing Address - Country:US
Mailing Address - Phone:906-353-6196
Mailing Address - Fax:906-353-8176
Practice Address - Street 1:116 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9676
Practice Address - Country:US
Practice Address - Phone:906-353-6196
Practice Address - Fax:906-353-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI071001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3001825Medicaid
MI0Z70002Medicare ID - Type Unspecified