Organization
LAKES MEDI-VAN INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY NUSTAD (OWNER, PRESIDENT)
(800) 422-0976
Entity
Organization
Contact information
Practice address
16777 LONGVIEW DRIVE, DETROIT LAKES, MN 56501
(800) 422-0976
(877) 417-4380
Mailing address
PO BOX 1053, DETROIT LAKES, MN 56502-1053
(800) 422-0976
(877) 417-4380
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
153577
MN
343900000X
Non-emergency Medical Transport (VAN)
Primary
153579
MN
343900000X
Non-emergency Medical Transport (VAN)
153581
MN
343900000X
Non-emergency Medical Transport (VAN)
153619
MN
343900000X
Non-emergency Medical Transport (VAN)
153636
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109465
UCARE
MN
01
—
11033LA
BLUE PLUS
MN
01
—
16726
HEALTH PARTNERS
MN
05
—
56330
—
ND
01
—
8120863
MEDICA
MN
05
—
9030210
—
SD
Enumeration date
02/12/2007
Last updated
08/28/2007
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