# CHEBOYGAN LIFE SUPPORT SYSTEMS INC

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

## Provider details

- **NPI number:** 1225059587
- **Authorized official:** MR. DALLAS LEE HYDE I PARAMEDIC (DIRECTOR OF CLSS)
- **Authorized official phone:** (231) 627-9348

## Contact information

- **Practice address:** 536 RIGGS DR, CHEBOYGAN, MI 49721-1063
- **Practice address phone:** (231) 627-9348
- **Practice address fax:** (231) 627-1658
- **Mailing address:** 536 RIGGS DR, P.O. BOX 105, CHEBOYGAN, MI 49721-1063
- **Mailing address phone:** (231) 627-9348
- **Mailing address fax:** (231) 627-1658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 161003 | MI | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1486558 | — | MI |
| 01 | — | 590A60009 | BLUE CROSS BLUE SHEILD | MI |
| 01 | — | P42574 | BLUE CARE NETWORK | — |