NPIMap

Organization Active NPI

Otsego County Ambulance Corps, Inc.

  • Land Ambulance
  • Gaylord, MI
National Provider Identifier
1205832656
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
691001 Issued in MI
Legal business name
OTSEGO COUNTY AMBULANCE CORPS, INC.
Practice address
100 McLouth Rd
Gaylord, MI 49735-9339
Phone
(989) 732-9085
Fax
(989) 732-9497
NPI assigned
Jun 21, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jon Deming
Title
Chief
Phone
(989) 732-9085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 691001 MI Primary

Addresses

Primary practice location

100 McLouth Rd
Gaylord, MI 49735-9339

Mailing address

PO Box 642
100 McLouth
Gaylord, MI 49734-0642
Phone (989) 732-9085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120203000611 MI Part B Supplier - Ambulance Service Supplier 2668639550 Practice locations: Gaylord, MI

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1205832656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 642",
            "address_2": "100 MCLOUTH",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497340642",
            "telephone_number": "989-732-9085",
            "fax_number": "989-732-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MCLOUTH RD",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359339",
            "telephone_number": "989-732-9085",
            "fax_number": "989-732-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTSEGO COUNTY AMBULANCE CORPS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "DEMING",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "989-732-9085",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MI",
            "license": "691001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.