1659397164 NPI number — MAYO CLINIC AMBULANCE

Table of content: (NPI 1659397164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659397164 NPI number — MAYO CLINIC AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYO CLINIC 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:
1659397164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 6TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-281-1226
Provider Business Mailing Address Fax Number:
507-288-9004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 6TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-2673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-281-1226
Provider Business Practice Location Address Fax Number:
507-288-9004
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRUCKER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
507-255-7955

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0208 , 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: 937318700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115714100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590012979 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 211911100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 660717900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00131221 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590013327 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590014431 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 562514900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590012788 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590014430 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590014432 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 590014433 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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