Provider Demographics
NPI:1073500427
Name:CITY OF COTTONWOOD
Entity Type:Organization
Organization Name:CITY OF COTTONWOOD
Other - Org Name:COTTONWOOD AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:507-828-1244
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56229-0106
Mailing Address - Country:US
Mailing Address - Phone:507-423-6488
Mailing Address - Fax:507-423-5368
Practice Address - Street 1:100 WEST 2ND STREET SOUTH
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:MN
Practice Address - Zip Code:56229-0106
Practice Address - Country:US
Practice Address - Phone:507-423-6488
Practice Address - Fax:507-423-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48189COOtherBCBS
MN902867600Medicaid
MN902867600Medicaid