Provider Demographics
NPI:1972550986
Name:TOWN OF LAND O LAKES
Entity Type:Organization
Organization Name:TOWN OF LAND O LAKES
Other - Org Name:LAND O' LAKES AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-547-3255
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:54540-0660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4337 HWY B
Practice Address - Street 2:
Practice Address - City:LAND O' LAKES
Practice Address - State:WI
Practice Address - Zip Code:54540
Practice Address - Country:US
Practice Address - Phone:715-547-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000088714OtherADVOCARE MCHMO
WI41342800Medicaid
WI0100OtherJOHN DEERE
MN323265400Medicaid
MI4591575Medicaid
WI41342800Medicaid
000088714OtherADVOCARE MCHMO
=========017OtherBCBS
590001857Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IL=========001Medicaid