1194859124 NPI number — CITY OF CLOQUET

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194859124 NPI number — CITY OF CLOQUET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CLOQUET
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLOQUET AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194859124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 CLOQUET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOQUET
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55720-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-879-3347
Provider Business Mailing Address Fax Number:
218-879-6555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 CLOQUET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOQUET
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55720-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-879-6514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRITSINGER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CITY ADMINISTRATOR
Authorized Official Telephone Number:
218-879-3347

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0053 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120910 . This is a "UCARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 75095CL . This is a "FIRST PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8180850 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75095CL . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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