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General NPI Number Information
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NPI Number | 1467593251
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Entity Type | Organization
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Legal Business Name | LAKES MEDI-VAN INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 16777 LONGVIEW DRIVE
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City | DETROIT LAKES
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State | MN
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Zip | 56501
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Country | US
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Telephone | 800-422-0976
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Fax | 877-417-4380
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Provider Business Mailing Address
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Address Line | PO BOX 1053
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City | DETROIT LAKES
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State | MN
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Zip | 56502-1053
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Country | US
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Telephone | 800-422-0976
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Fax | 877-417-4380
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MR. JEFFREY NUSTAD
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Credential |
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Telephone | 800-422-0976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 153619
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 153636
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 153581
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 153577
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 153579
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License Number State | MN
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