Provider Demographics
NPI:1053308494
Name:CITY OF BERTHA
Entity Type:Organization
Organization Name:CITY OF BERTHA
Other - Org Name:BERTHA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:E
Authorized Official - Last Name:UMLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-924-4454
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:113 2ND AVE NW
Mailing Address - City:BERTHA
Mailing Address - State:MN
Mailing Address - Zip Code:56437-0065
Mailing Address - Country:US
Mailing Address - Phone:218-924-4454
Mailing Address - Fax:218-924-4373
Practice Address - Street 1:127 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:BERTHA
Practice Address - State:MN
Practice Address - Zip Code:56437
Practice Address - Country:US
Practice Address - Phone:218-924-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN671267300Medicaid
MN81208BEOtherBC & BS
MN81208BEOtherBC & BS