Healthcare Provider Details

I. General information

NPI: 1073683017
Provider Name (Legal Business Name): LAKE COUNTY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BANKS BLVD.
SILVER BAY MN
55614-0066
US

IV. Provider business mailing address

421 20TH AVE
TWO HARBORS MN
55616-1364
US

V. Phone/Fax

Practice location:
  • Phone: 218-226-4423
  • Fax:
Mailing address:
  • Phone: 218-834-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0230
License Number StateMN

VIII. Authorized Official

Name: MR. PATRICK WILLIAM LEE
Title or Position: CEO DIRECTOR
Credential:
Phone: 218-834-7110