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Organization
LAKESIDE EMS LLC
Active
Organization
LAKESIDE EMS LLC
Active
Other names
Lakeside EMS LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JERROD ESTES (CEO/PARAMEDIC)
(217) 994-2046
Entity
Organization
Contact information
Practice address
815 S MAPLE ST, EFFINGHAM, IL 62401-2641
(217) 994-2046
(724) 794-1633
Mailing address
815 S MAPLE ST, EFFINGHAM, IL 62401-2641
(217) 994-2046
(724) 794-1633
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
060409935
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5219-01
LICENSE NUMBER
IL
Enumeration date
04/02/2018
Last updated
08/09/2021
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