Healthcare Provider Details

I. General information

NPI: 1881334324
Provider Name (Legal Business Name): LSA INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 FENCELINE DR
JACKSON WI
53037-8931
US

IV. Provider business mailing address

2302 FENCELINE DR
JACKSON WI
53037-8931
US

V. Phone/Fax

Practice location:
  • Phone: 414-364-7908
  • Fax:
Mailing address:
  • Phone: 414-364-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KWABENA YEBOAH ACHEAMPONG
Title or Position: CEO
Credential:
Phone: 414-364-7908