Organization
BEACON AMBULANCE SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN KUTZ (OWNER)
(715) 561-3200
Entity
Organization
Contact information
Practice address
101 E CLOVERLAND DR, IRONWOOD, MI 49938-1227
(906) 932-3434
Mailing address
300 VILLA DR, HURLEY, WI 54534-1523
(715) 561-3200
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
6000577
WI
341600000X
Ambulance
Primary
991001
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41335300
—
WI
01
—
590B70005
BLUE CROSS BLUE SHIELD
MI
05
—
9512565
—
MI
Enumeration date
05/05/2006
Last updated
09/20/2021
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