1154411205 NPI number — CITY OF LEWISTON

Table of content: (NPI 1154411205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154411205 NPI number — CITY OF LEWISTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LEWISTON
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:
LEWISTON VOLUNTEER AMBULANCE
Provider Other Organization Name Type Code:
5
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:
1154411205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55952-0722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-523-2257
Provider Business Mailing Address Fax Number:
507-523-2306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 RICE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-523-2257
Provider Business Practice Location Address Fax Number:
507-523-2306
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESSIG
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
AMBULANCE DIRECTOR
Authorized Official Telephone Number:
507-523-2982

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0135 , 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: 38250LE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 773267800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81380 . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8182873 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590013759 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 170133 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".




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