# INTEGRATED FIRST RESPONSE-GREAT LAKES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083044762
- **Authorized official:** DOUGLAS D ANDERSON (TREASURER)
- **Authorized official phone:** (605) 366-3299

## Contact information

- **Practice address:** 719 RIVER AVENUE, IRON MOUNTAIN, MI 49801
- **Practice address phone:** (855) 437-9111
- **Practice address fax:** (605) 582-8983
- **Mailing address:** PO BOX 1137, HERNDON, VA 20172-1137
- **Mailing address phone:** (855) 437-9114
- **Mailing address fax:** (866) 388-5227

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 221010 | MI | Yes |

## Other

- **Enumeration date:** 11/18/2013
- **Last updated:** 11/18/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | MI6850 | MEDICARE PTAN | MI |