1881764041 NPI number — SPRING GROVE AMBULANCE CORPORATION

Table of content: MICHAEL W CHITWOOD M.D. (NPI 1548298912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881764041 NPI number — SPRING GROVE AMBULANCE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRING GROVE AMBULANCE CORPORATION
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:
6
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:
1881764041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 122
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55974-0122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-498-3098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
192 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55974-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-498-3098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
507-459-1948

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39737SP . This is a "BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 39737SP . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 761367900 . This is a "MHCP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".