MEDICARE: LAKES REGION EMS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	0177	MN
2	3416L0300X	Land Ambulance	0211	MN
3	3416L0300X	Land Ambulance	0048	MN

General Provider Information

NPI Number	:	1487685947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKES REGION EMS, INC.

Provider Business Mailing Address
First Line	:	40245 FLETCHER AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6109
Country	:	US
Telephone Number	:	651-243-5505
Fax Number	:	651-674-4628

Provider Business Practice Location Address
First Line	:	40245 FLETCHER AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6109
Country	:	US
Telephone Number	:	651-243-5505
Fax Number	:	651-674-4628

Authorized Official
Title or Position	:	DIRECTOR OF ADMINSTRATION
Name	:	MICHELLE ANDERSON
Credential	:
Telephone Number	:	651-243-5502

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/10/2022

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Directions to “LAKES REGION EMS, INC. ” Practice Location

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