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General NPI Number Information
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NPI Number | 1073683017
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY AMBULANCE
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 87 BANKS BLVD.
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City | SILVER BAY
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State | MN
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Zip | 55614-0066
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Country | US
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Telephone | 218-226-4423
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Fax |
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Provider Business Mailing Address
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Address Line | 421 20TH AVE
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City | TWO HARBORS
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State | MN
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Zip | 55616-1364
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Country | US
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Telephone | 218-834-7110
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Fax |
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Authorized Official
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Title or Position | CEO DIRECTOR
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Name | MR. PATRICK WILLIAM LEE
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Credential |
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Telephone | 218-834-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0230
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License Number State | MN
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