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General NPI Number Information
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NPI Number | 1538293949
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Entity Type | Organization
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Legal Business Name | LAKE MILLS EMERGENCY MEDICAL SERVICES INC.
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 603 E LAKE ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1738
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Country | US
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Telephone | 920-648-5888
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Fax | 920-648-8627
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Provider Business Mailing Address
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Address Line | 603 E LAKE ST PO BOX 162
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City | LAKE MILLS
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State | WI
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Zip | 53551-1738
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Country | US
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Telephone | 920-648-5888
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Fax | 920-648-8627
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Authorized Official
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Title or Position | TREASURER
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Name | DEREK BLOMGREN
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Credential |
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Telephone | 920-285-6393
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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 | 60-1031
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License Number State | WI
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