City of Ecorse
Organization Active NPI Land Ambulance · Ecorse, MI
NPI 1487722682 · NPPES record last updated Dec 13, 2022
Key facts
- NPI
- 1487722682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 821005 (MI)
- Legal business name
- CITY OF ECORSE
- Practice address
- 3869 W Jefferson Ave
Ecorse, MI 48229-1701 - Phone
- (313) 381-6889
- Fax
- (313) 386-8162
- NPI assigned
- Dec 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Franklin Hayes
- Title
- Administrator
- Phone
- (313) 779-9032
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1094580 | Ecorse Fire Department | Certificate of waiver | Oct 19, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080212000073 | MI | Part B Supplier - Ambulance Service Supplier | 0244313443 | Practice locations: Ecorse, MI |
National Provider Directory
Locations
3869 W Jefferson Ave
Ecorse, MI 48229
Phone (313) 381-0720
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 821005 | MI | Yes |
Addresses
Primary practice location
3869 W Jefferson Ave
Ecorse, MI 48229-1701
Mailing address
3869 W Jefferson Ave
Ecorse, MI 48229-1701
Phone (313) 381-6889
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 183005109 | Medicaid | MI | |
| 590H200990 | Other | MI | BLUE CROSS BLUE SHIELD |
Other names
- ECORSE FIRE DEPARTMENT
Other providers in Ecorse, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.