1811025158 NPI number — LOWER ST CROIX VALLEY FIRE PROTECTION DISTRICT

Table of content: (NPI 1811025158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811025158 NPI number — LOWER ST CROIX VALLEY FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER ST CROIX VALLEY FIRE PROTECTION DISTRICT
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:
LOWER ST. CROIX VALLEY 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:
1811025158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55043-0234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 SAINT CROIX TRL S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55043-9311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-436-7033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
FREMOND
Authorized Official Title or Position:
DEPUTY CHIEF
Authorized Official Telephone Number:
651-436-7033

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , 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: 173867400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590013825 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 27764CR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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