1013139583 NPI number — CITY OF HIBBING

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 1013139583 NPI number — CITY OF HIBBING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF HIBBING
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:
HIBBING 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:
1013139583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIBBING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55746-3897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-312-3002
Provider Business Mailing Address Fax Number:
218-312-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 BROOKLYN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIBBING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55746-1955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-312-3002
Provider Business Practice Location Address Fax Number:
218-312-3003
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RENSKERS
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
218-362-6683

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , 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: 69331HI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 112096 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 232767800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590656409 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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