Provider Demographics
NPI:1053471888
Name:PARKERS PRAIRIE COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:PARKERS PRAIRIE COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-338-4357
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:PARKERS PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56361-0115
Mailing Address - Country:US
Mailing Address - Phone:218-233-5658
Mailing Address - Fax:218-233-7630
Practice Address - Street 1:102 NORTH OTTER AVENUE
Practice Address - Street 2:
Practice Address - City:PARKERS PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56361
Practice Address - Country:US
Practice Address - Phone:218-233-5658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1A368PAOtherBLUE CROSS BLUE SHIELD