Provider Demographics
NPI:1538293949
Name:LAKE MILLS EMERGENCY MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:LAKE MILLS EMERGENCY MEDICAL SERVICES INC.
Other - Org Name:LM EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-285-6393
Mailing Address - Street 1:603 E LAKE ST
Mailing Address - Street 2:PO BOX 162
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1738
Mailing Address - Country:US
Mailing Address - Phone:920-648-5888
Mailing Address - Fax:920-648-8627
Practice Address - Street 1:603 E LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1738
Practice Address - Country:US
Practice Address - Phone:920-648-5888
Practice Address - Fax:920-648-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60-10313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000085313Medicare ID - Type Unspecified