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General NPI Number Information
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NPI Number | 1356058713
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Entity Type | Organization
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Legal Business Name | CITY OF LAKE MILLS
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 120 VETERANS LN
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City | LAKE MILLS
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State | WI
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Zip | 53551-1555
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Country | US
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Telephone | 920-648-5117
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Fax | 920-648-8743
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Provider Business Mailing Address
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Address Line | 200D WATER ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1632
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Country | US
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Telephone | 920-648-5117
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Fax | 920-648-8743
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. JOEL SCOTT THEDER
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Credential | AEMT
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Telephone | 920-648-5117
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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 |
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License Number State |
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