Provider Demographics
NPI:1104972611
Name:LE CENTER VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:LE CENTER VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOETTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-357-8285
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:LE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057
Mailing Address - Country:US
Mailing Address - Phone:507-357-8285
Mailing Address - Fax:
Practice Address - Street 1:136 S CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1804
Practice Address - Country:US
Practice Address - Phone:507-357-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30350LEOtherBCBS
MN121275OtherUCARE
8181754OtherMEDICU
MN273367600Medicaid
599000164Medicare ID - Type Unspecified