East Bay Charter Township

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

28 1001 Issued in MI

Legal business name

EAST BAY CHARTER TOWNSHIP

Doing business as

East Bay Ambulance

Practice address

110 High Lake Rd
Traverse City, MI 49686-8136

Phone

(231) 947-0299

Fax

(231) 947-0602

NPI assigned

Jan 15, 2007

Organization subpart

Yes

Parent organization

EAST BAY CHARTER TOWNSHIPAs reported in NPPES

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

Authorized official

Name

Nicholas Lemcool

Title

Ambulance Director

Phone

(231) 947-0299

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• East Bay Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

East Bay Charter Township

Locations

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1306997598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 HIGH LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968136",
            "telephone_number": "231-947-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 HIGH LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868136",
            "telephone_number": "231-947-0299",
            "fax_number": "231-947-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BAY CHARTER TOWNSHIP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST BAY CHARTER TOWNSHIP",
        "enumeration_date": "2007-01-15",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "LEMCOOL",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "AMBULANCE DIRECTOR",
        "authorized_official_telephone_number": "231-947-0299"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MI",
            "license": "28 1001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590009133",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2968239",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Bay Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alycia Rae Dzierwa, FNP-C
• Samantha Lin Dzierzyc, PHARMD
• E. a. Austin DO PC
• Earlene Blevins, Ma, LPC
• Earthenwell Therapeutic Massage
• East Bay Family Dentistry
• East Bay Psychology, PC
• Keith W Eaton, M.D.
• Sarah J Eberhard, CRNA
• Alicia Morgan Eby, MD

• Land Ambulance in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Land Ambulance in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.