Provider Demographics
NPI:1114025848
Name:CITY OF HOWARD LAKE
Entity Type:Organization
Organization Name:CITY OF HOWARD LAKE
Other - Org Name:HOWARD LAKE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-543-2001
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-0309
Mailing Address - Country:US
Mailing Address - Phone:320-543-2001
Mailing Address - Fax:
Practice Address - Street 1:835 7TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-0309
Practice Address - Country:US
Practice Address - Phone:320-543-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MN01113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1021786OtherPREFERREDONE
MN81-80704OtherMEDICA
MN57147HOOtherBCBS
MN842767400Medicaid