# BEACON AMBULANCE SERVICE, INC.

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

## Provider details

- **NPI number:** 1649228123
- **Authorized official:** MR. JOHN KUTZ (OWNER)
- **Authorized official phone:** (715) 561-3200

## Contact information

- **Practice address:** 101 E CLOVERLAND DR, IRONWOOD, MI 49938-1227
- **Practice address phone:** (906) 932-3434
- **Mailing address:** 300 VILLA DR, HURLEY, WI 54534-1523
- **Mailing address phone:** (715) 561-3200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 6000577 | WI | — |
| 341600000X | Ambulance | 991001 | MI | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 09/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41335300 | — | WI |
| 01 | — | 590B70005 | BLUE CROSS BLUE SHIELD | MI |
| 05 | — | 9512565 | — | MI |