| Organization Name: | LAKESIDE QRU, INC |
| NPI Number: | 1205875978 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN R UNGARETTI (GENERAL MANAGER) |
| Mailing Address: | 125 Bills Rd Lakeside |
| State: | MT US |
| Postal Code: | 59922 |
| Phone Number: | 4068442775 |
| Fax Number: | 4068443663 |
| NPI Enumeration Date: | 06/06/2006 |
| NPI Last Update Date: | 10/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 152 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |