Provider Demographics
NPI:1902076581
Name:GREAT LAKES MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:GREAT LAKES MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAUVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-422-5625
Mailing Address - Street 1:2831 S LOXLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9246
Mailing Address - Country:US
Mailing Address - Phone:989-422-5625
Mailing Address - Fax:
Practice Address - Street 1:2600 TONAWANDA LAKE RD
Practice Address - Street 2:
Practice Address - City:GRAWN
Practice Address - State:MI
Practice Address - Zip Code:49637-9616
Practice Address - Country:US
Practice Address - Phone:989-422-5629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)