Provider Demographics
NPI:1598768012
Name:LAKE MILLS AMBULANCE SERVICE
Entity Type:Organization
Organization Name:LAKE MILLS AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-592-5772
Mailing Address - Street 1:105 S 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:IA
Mailing Address - Zip Code:50450-1510
Mailing Address - Country:US
Mailing Address - Phone:641-592-5772
Mailing Address - Fax:641-592-4300
Practice Address - Street 1:105 S 1ST AVE W
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:IA
Practice Address - Zip Code:50450-1510
Practice Address - Country:US
Practice Address - Phone:641-592-5772
Practice Address - Fax:641-592-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-30
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29504003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05421Medicare PIN