City of Lake Mills

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

CITY OF LAKE MILLS

Practice address

120 Veterans LN
Lake Mills, WI 53551-1555

Phone

(920) 648-5117

Fax

(920) 648-8743

NPI assigned

Nov 3, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joel Scott Theder, AEMT

Title

Captain

Phone

(920) 648-5117

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• City of Lake Mills Fire Department Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1356058713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200D WATER ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511632",
            "telephone_number": "920-648-5117",
            "fax_number": "920-648-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 VETERANS LN",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511555",
            "telephone_number": "920-648-5117",
            "fax_number": "920-648-8743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF LAKE MILLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "THEDER",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "920-648-5117",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "AEMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SERVICE LICENSE NUMBER",
            "identifier": "6600034",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "City of Lake Mills Fire Department",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "City of Lake Mills Fire Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shelly L. Borges, R.N.
• Jonathan J Brodie, MD
• Maureen Gale Buss, LCSW
• Kimberly Ann Caucutt, PTA
• Christopher James Kroll LLC
• Sarah Clement, M.A. CCC-SLP
• Country Cares LLC
• Dental Associates of Lake Mills, Inc.
• Ear Clinic, LLC
• Lynne M. Edebohls, APNP

• Land Ambulance in Lake Mills, WI
• Providers in Lake Mills, WI by specialty
• Land Ambulance in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.