Ontwa Jefferson Mason Milton Calvin Tnshps & Village of Edwardsburg

Primary specialty

AmbulanceTaxonomy code 341600000X

License

141003 Issued in MI

Legal business name

ONTWA JEFFERSON MASON MILTON CALVIN TNSHPS & VILLAGE OF EDWARDSBURG

Practice address

26273 E Shore Dr
Edwardsburg, MI 49112-8453

Phone

(269) 663-2347

Fax

(269) 663-0072

NPI assigned

Jun 18, 2006

Organization subpart

No

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

Authorized official

Name

Dennis Closson, PARAMEDIC

Title

Administrator

Phone

(269) 663-8022

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Edwardsburg 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

Locations

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1801831375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 384",
            "city": "EDWARDSBURG",
            "state": "MI",
            "postal_code": "491120384",
            "telephone_number": "269-663-8022",
            "fax_number": "269-663-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26273 E SHORE DR",
            "city": "EDWARDSBURG",
            "state": "MI",
            "postal_code": "491128453",
            "telephone_number": "269-663-2347",
            "fax_number": "269-663-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONTWA JEFFERSON MASON MILTON CALVIN TNSHPS & VILLAGE OF EDWARDSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "CLOSSON",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "269-663-8022",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MI",
            "license": "141003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001530",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edwardsburg Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindsey Danielle Lira, M.D.
• Drew Allen Mikel
• Britney J Monaco
• Daniela Arlette Moreno, CCC-SLP
• Alexander Moskalow
• Regional Home Care of Michigan Inc
• Samar and Ranya Inc
• Gina Schade, IHP
• Melisa Michelle Shafer, PT
• Katie Smith, LCSW

• Ambulance in Edwardsburg, MI
• Providers in Edwardsburg, MI by specialty
• Ambulance in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.