Organization
CHEBOYGAN LIFE SUPPORT SYSTEMS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALLAS LEE HYDE I PARAMEDIC (DIRECTOR OF CLSS)
(231) 627-9348
Entity
Organization
Contact information
Practice address
536 RIGGS DR, CHEBOYGAN, MI 49721-1063
(231) 627-9348
(231) 627-1658
Mailing address
536 RIGGS DR, P.O. BOX 105, CHEBOYGAN, MI 49721-1063
(231) 627-9348
(231) 627-1658
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
161003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486558
—
MI
01
—
590A60009
BLUE CROSS BLUE SHEILD
MI
01
—
P42574
BLUE CARE NETWORK
—
Enumeration date
07/22/2006
Last updated
08/22/2020
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