=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609946573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF LAKE LILLIAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 LAKEVIEW ST
-----------------------------------------------------
City | LAKE LILLIAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-664-4440
-----------------------------------------------------
Fax | 320-664-4440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 531 LAKEVIEW ST PO BOX 7
-----------------------------------------------------
City | LAKE LILLIAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-664-4440
-----------------------------------------------------
Fax | 320-664-4440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CITY CLERK AND TREASURER
-----------------------------------------------------
Name | SUSAN JUNGCLAUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-664-4440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 0129
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------