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Contact Information

LAKES MEDI-VAN INC.
16777 LONGVIEW DRIVE
DETROIT LAKES, MN56501
 Phone: 800-422-0976
 Fax: 877-417-4380
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Non-emergency Medical Transport (VAN)

343900000X
Indicates primary specialty

NPI Profile & details for LAKES MEDI-VAN INC.

NPI Number 1467593251
LBN Legal business name LAKES MEDI-VAN INC.
Authorized official JEFFREY NUSTAD - (OWNER, PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 02/12/2007
Last updated 08/28/2007 - About 19 years ago
Identifiers
MN License # 153577
MN License # 153579
MN License # 153581
MN License # 153619
MN License # 153636
ND Medicaid 56330
SD Medicaid 9030210
MN Other 11033LA BLUE PLUS
MN Other 16726 HEALTH PARTNERS
MN Other 8120863 MEDICA
MN Other 109465 UCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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