Provider Demographics
NPI:1487685947
Name:LAKES REGION EMS, INC.
Entity Type:Organization
Organization Name:LAKES REGION EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINSTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-243-5502
Mailing Address - Street 1:40245 FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6109
Mailing Address - Country:US
Mailing Address - Phone:651-243-5505
Mailing Address - Fax:651-674-4628
Practice Address - Street 1:40245 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6109
Practice Address - Country:US
Practice Address - Phone:651-243-5505
Practice Address - Fax:651-674-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01773416L0300X
MN00483416L0300X
MN02113416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport