Organization
INTEGRATED FIRST RESPONSE-GREAT LAKES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS D ANDERSON (TREASURER)
(605) 366-3299
Entity
Organization
Contact information
Practice address
719 RIVER AVENUE, IRON MOUNTAIN, MI 49801
(855) 437-9111
(605) 582-8983
Mailing address
PO BOX 1137, HERNDON, VA 20172-1137
(855) 437-9114
(866) 388-5227
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
221010
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI6850
MEDICARE PTAN
MI
Enumeration date
11/18/2013
Last updated
11/18/2013
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