Healthcare Provider Details

I. General information

NPI: 1487685947
Provider Name (Legal Business Name): LAKES REGION EMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40245 FLETCHER AVE
NORTH BRANCH MN
55056-6109
US

IV. Provider business mailing address

40245 FLETCHER AVE
NORTH BRANCH MN
55056-6109
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-5505
  • Fax: 651-674-4628
Mailing address:
  • Phone: 651-243-5505
  • Fax: 651-674-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0177
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0211
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0048
License Number StateMN

VIII. Authorized Official

Name: MICHELLE ANDERSON
Title or Position: DIRECTOR OF ADMINSTRATION
Credential:
Phone: 651-243-5502