Provider Demographics
NPI:1295959617
Name:TRI-TOWNSHIP AMBULANCE AUTHORITY
Entity type:Organization
Organization Name:TRI-TOWNSHIP AMBULANCE AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRI-TOWNSHIP AMBULANCE AUTHORITY BO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-280-6402
Mailing Address - Street 1:W2308 HWY M 69
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49834-0000
Mailing Address - Country:US
Mailing Address - Phone:906-246-3832
Mailing Address - Fax:906-246-3832
Practice Address - Street 1:W2308 HWY M69
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:MI
Practice Address - Zip Code:49834-0000
Practice Address - Country:US
Practice Address - Phone:906-246-3832
Practice Address - Fax:906-246-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2210013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3005136Medicaid
MI3005136Medicaid
MI3005136Medicaid