Provider Demographics
NPI:1023179033
Name:GREAT PLAINS EMS, INC.
Entity Type:Organization
Organization Name:GREAT PLAINS EMS, INC.
Other - Org Name:GREAT PLAINS EMS, CROOKSTON BRANCH
Other - Org Type:Other Name
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-281-6332
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-0388
Mailing Address - Country:US
Mailing Address - Phone:218-281-6332
Mailing Address - Fax:
Practice Address - Street 1:201 W LORING ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1943
Practice Address - Country:US
Practice Address - Phone:218-281-6332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8G858GROtherBCBS PROVIDER NUMBER