Active NPI
Higgins Township Roscommon County Mich
- Land Ambulance
- Roscommon, MI
National Provider Identifier
1902021355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- HIGGINS TOWNSHIP ROSCOMMON COUNTY MICH
- Practice address
- 700 South Fifth Street
Roscommon, MI 48653 - Phone
- (989) 275-8112
- Fax
- (989) 275-8990
- NPI assigned
- Apr 13, 2007
- Last updated
- Mar 14, 2024
- Organization subpart
- Yes
- Parent organization
- HIGGINS TOWNSHIP EMS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark A Grace
- Title
- Assistant Fire and EMS Coordinator
- Phone
- (989) 275-5229
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 721008 | MI | |
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
700 South Fifth Street
Roscommon, MI 48653
Mailing address
PO Box 2122
Riverview, MI 48193-1122
Phone (734) 479-6300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 181971418 | Medicaid | MI | |
| 590G200070 | Other | MI | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120605000246 | MI | Part B Supplier - Ambulance Service Supplier | 6406010388 | Practice locations: Roscommon, MI |
National Provider Directory
National Provider Directory- Part of
- Higgins Township Roscommon County Mich
Locations
700 S 5th St
Roscommon, MI 48653
Phone (734) 479-6300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1710374400000",
"number": "1902021355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2122",
"city": "RIVERVIEW",
"state": "MI",
"postal_code": "481931122",
"telephone_number": "734-479-6300",
"fax_number": "734-479-6319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 SOUTH FIFTH STREET",
"city": "ROSCOMMON",
"state": "MI",
"postal_code": "48653",
"telephone_number": "989-275-8112",
"fax_number": "989-275-8990"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGGINS TOWNSHIP ROSCOMMON COUNTY MICH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HIGGINS TOWNSHIP EMS",
"enumeration_date": "2007-04-13",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A",
"authorized_official_last_name": "GRACE",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "ASSISTANT FIRE AND EMS COORDINATOR",
"authorized_official_telephone_number": "989-275-5229"
},
"taxonomies": [
{
"code": "341600000X",
"taxonomy_group": "",
"desc": "Ambulance",
"state": "MI",
"license": "721008",
"primary": false
},
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "181971418",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "590G200070",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roscommon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; 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.