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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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