1235323874 NPI number — FREEBORN FIRE & AMBULANCE

Table of content: (NPI 1235323874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235323874 NPI number — FREEBORN FIRE & AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEBORN FIRE & AMBULANCE
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:
Provider Other Organization Name Type Code:
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:
1235323874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 OAK ST
Provider Second Line Business Mailing Address:
PO BOX 272
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55024-1358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-463-3867
Provider Business Mailing Address Fax Number:
651-460-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEBORN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56032-0099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-863-2204
Provider Business Practice Location Address Fax Number:
507-863-2521
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEIPP
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
507-863-2204

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0385 , 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: 176267200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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