Cheboygan Life Support Systems Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

161003 Issued in MI

Legal business name

CHEBOYGAN LIFE SUPPORT SYSTEMS INC

Practice address

536 Riggs Dr
Cheboygan, MI 49721-1063

Phone

(231) 627-9348

Fax

(231) 627-1658

NPI assigned

Jul 22, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dallas Lee Hyde I, PARAMEDIC

Title

Director of CLSS

Phone

(231) 627-9348

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225059587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 RIGGS DR",
            "address_2": "P.O. BOX 105",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497211063",
            "telephone_number": "231-627-9348",
            "fax_number": "231-627-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 RIGGS DR",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497211063",
            "telephone_number": "231-627-9348",
            "fax_number": "231-627-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEBOYGAN LIFE SUPPORT SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR OF CLSS",
        "authorized_official_telephone_number": "231-627-9348",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MI",
            "license": "161003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1486558",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P42574",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "590A60009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassie Lynne Charboneau
• Cheboygan Area High School - Counseling Room
• Cheboygan Chiropractic Clinic Inc
• Cheboygan County Council on Aging
• Cheboygan Dental Associates Inc
• Cheboygan Opco LLC (Medilodge of Cheboygan)
• Robin A Chezick, B.S.N.
• Dominic D Collino, D.C.
• Community Memorial Hospital
• Community Memorial Hospital (Cheboygan Memorial Hospital)

• Land Ambulance in Cheboygan, MI
• Providers in Cheboygan, MI by specialty
• Land Ambulance in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.