Organization
LAKESHORE EMS
Active
Other names
Lakeshore EMS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK R MONTOYA (OWNER)
(219) 945-3607
Entity
Organization
Contact information
Practice address
3480 E 83RD PL, MERRILLVILLE, IN 46410-6547
(219) 663-2896
(219) 794-1077
Mailing address
3480 E 83RD PL, MERRILLVILLE, IN 46410-6547
(219) 663-2896
(219) 794-1077
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
3416L0300X
Land Ambulance
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201135230
—
IN
Enumeration date
10/20/2011
Last updated
05/05/2016
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