Provider Demographics
NPI:1285724047
Name:AMERICAN AMBULANCE COMPANY
Entity type:Organization
Organization Name:AMERICAN AMBULANCE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENDA
Authorized Official - Middle Name:ILENE
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-961-0876
Mailing Address - Street 1:1050 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1939
Mailing Address - Country:US
Mailing Address - Phone:313-961-0876
Mailing Address - Fax:
Practice Address - Street 1:1050 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1939
Practice Address - Country:US
Practice Address - Phone:313-961-0876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI59OH20009OtherBLUE CROSS
MIOH20009Medicare ID - Type Unspecified