Lakes Medi-Van Inc.

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

153579 Issued in MN

Legal business name

LAKES MEDI-VAN INC.

Practice address

16777 Longview Drive
Detroit Lakes, MN 56501

Phone

(800) 422-0976

Fax

(877) 417-4380

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Nustad

Title

Owner, President

Phone

(800) 422-0976

Specialties & licenses 5

Addresses

Other identifiers 6

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1467593251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1053",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565021053",
            "telephone_number": "800-422-0976",
            "fax_number": "877-417-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16777 LONGVIEW DRIVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "800-422-0976",
            "fax_number": "877-417-4380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKES MEDI-VAN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-08-28",
        "status": "A",
        "authorized_official_last_name": "NUSTAD",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "800-422-0976",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "153579",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "153619",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "153636",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "153581",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "153577",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS",
            "identifier": "11033LA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "8120863",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "16726",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56330",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "109465",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9030210",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lakeland Chiropractic Clinic
• Lakeridge Dental Partners, PLLC
• Lakes Country Healthcare P.L.L.C.
• Lakes Crisis & Resource Center
• Lakes Homes and Program Development, Inc.
• Lakes Vision, PC
• Lola S Lalonde
• A. Douglas Landers, MD
• Alyson Rose Larson, PHARMD
• Heather Larson, LGSW

• Non-emergency Medical Transport (VAN) in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Non-emergency Medical Transport (VAN) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.