1548327778 NPI number — PERHAM AREA EMS

Table of content: MRS. ELIZABETH ETHRIDGE BEASLEY CRNA (NPI 1225695414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548327778 NPI number — PERHAM AREA EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERHAM AREA EMS
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:
1548327778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERHAM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56573-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-346-4440
Provider Business Mailing Address Fax Number:
218-346-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERHAM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56573-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-346-4440
Provider Business Practice Location Address Fax Number:
218-346-9795
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARTHAN
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
NELS
Authorized Official Title or Position:
DIRECTOR OF EMS
Authorized Official Telephone Number:
218-346-4485

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  MN017 , 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: 932767300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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