# WHITE LAKE AMBULANCE SERVICE

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

## Provider details

- **NPI number:** 1225033855
- **Authorized official:** MR. JONATHON DEGEN (DIRECTOR)
- **Authorized official phone:** (231) 894-4306

## Contact information

- **Practice address:** 5085 WILCOX ST, MONTAGUE, MI 49437-1558
- **Practice address phone:** (231) 894-4306
- **Practice address fax:** (231) 893-0249
- **Mailing address:** 5085 WILCOX ST, MONTAGUE, MI 49437-1558
- **Mailing address phone:** (231) 894-4306
- **Mailing address fax:** (231) 893-0249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 611002 | MI | Yes |

## Other

- **Enumeration date:** 06/20/2005
- **Last updated:** 06/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4217295 | — | MI |