Provider Demographics
NPI:1083866529
Name:LYON-LINCOLN ELECTRIC COOPERATIVE, INC.
Entity Type:Organization
Organization Name:LYON-LINCOLN ELECTRIC COOPERATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-247-5505
Mailing Address - Street 1:205 E HIGHWAY 14
Mailing Address - Street 2:P.O. BOX 639
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-9310
Mailing Address - Country:US
Mailing Address - Phone:507-247-5505
Mailing Address - Fax:507-247-5508
Practice Address - Street 1:205 E HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178-9310
Practice Address - Country:US
Practice Address - Phone:507-247-5505
Practice Address - Fax:507-247-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN984713800Medicaid