Healthcare Provider Details

I. General information

NPI: 1457346223
Provider Name (Legal Business Name): LAKE COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 20TH AVE
TWO HARBORS MN
55616
US

IV. Provider business mailing address

421 20TH AVE
TWO HARBORS MN
55616
US

V. Phone/Fax

Practice location:
  • Phone: 218-834-7110
  • Fax: 218-834-9587
Mailing address:
  • Phone: 218-834-7110
  • Fax: 218-834-9587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0248
License Number StateMN

VIII. Authorized Official

Name: MS. DANIELLE DENEUI
Title or Position: DIRECTOR/CEO
Credential:
Phone: 218-834-7110