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General NPI Number Information
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NPI Number | 1689567646
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Entity Type | Organization
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Legal Business Name | LOON LAKE EMS, LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 07/05/2025
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Provider Practice Location Address
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Address Line | 433 S 7TH ST APT 1801
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1641
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Country | US
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Telephone | 406-334-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 433 S 7TH ST APT 1801
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1641
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Country | US
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Telephone | 406-334-4005
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHAEL JOSEPH MERRELL
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Credential | NREMT
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Telephone | 406-334-4005
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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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