1548366248 NPI number — ELK RIVER FIRE & AMBULANCE SERVICE

Table of content: (NPI 1548366248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548366248 NPI number — ELK RIVER FIRE & AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELK RIVER FIRE & AMBULANCE SERVICE
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:
1548366248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 JACKSON AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK RIVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-441-2733
Provider Business Mailing Address Fax Number:
763-441-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 JACKSON AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK RIVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55330-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-441-2733
Provider Business Practice Location Address Fax Number:
763-441-4050
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DITTBENNER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
AMBULANCE COORDINATOR
Authorized Official Telephone Number:
763-441-2733

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  073 , 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: 8180255 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 106310 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1007550 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8181676 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 38849EL . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com