Organization
CIVIL CITY OF LAKE STATION IND
Active
Organization
CIVIL CITY OF LAKE STATION IND
Active
Other names
City of Lake Station
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES FAZEKAS (FIRE CHIEF)
(219) 945-6629
Entity
Organization
Contact information
Practice address
1876 FAIRVIEW AVE, LAKE STATION, IN 46405
(219) 962-8295
Mailing address
1969 CENTRAL AVE, LAKE STATION, IN 46405-2059
(219) 962-2081
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0291
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215119
ANTHEM
IN
05
—
200262890A
—
IN
Enumeration date
11/22/2006
Last updated
06/06/2024
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