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General NPI Number Information
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NPI Number | 1316931512
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Entity Type | Organization
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Legal Business Name | LAKE-SUMTER EMERGENCY MEDICAL SERVICES
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 2761 W OLD US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-3500
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Country | US
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Telephone | 352-383-4554
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Fax | 352-385-9063
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Provider Business Mailing Address
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Address Line | 2761 W OLD US HWY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-3500
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Country | US
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Telephone | 352-383-4554
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Fax | 352-385-9063
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Authorized Official
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Title or Position | PFS MANAGER
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Name | MR. BRYAN PORTER ANDREWS
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Credential |
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Telephone | 352-385-2530
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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 | 2513
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License Number State | FL
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