MEDICARE: LAKE-SUMTER EMERGENCY MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2513	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316931512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE-SUMTER EMERGENCY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2761 W OLD US HWY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-3500
Country	:	US
Telephone Number	:	352-383-4554
Fax Number	:	352-385-9063

Provider Business Practice Location Address
First Line	:	2761 W OLD US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-3500
Country	:	US
Telephone Number	:	352-383-4554
Fax Number	:	352-385-9063

Authorized Official
Title or Position	:	PFS MANAGER
Name	:	MR. BRYAN PORTER ANDREWS
Credential	:
Telephone Number	:	352-385-2530

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	04/08/2014

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