Provider Demographics
NPI:1073634291
Name:CITY OF WABASSO
Entity Type:Organization
Organization Name:CITY OF WABASSO
Other - Org Name:WABASSO AMBULANCE ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY CLERKTREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-342-5519
Mailing Address - Street 1:1225 OAK ST
Mailing Address - Street 2:P O BOX 60
Mailing Address - City:WABASSO
Mailing Address - State:MN
Mailing Address - Zip Code:56293-0060
Mailing Address - Country:US
Mailing Address - Phone:507-342-5519
Mailing Address - Fax:507-342-2213
Practice Address - Street 1:1225 OAK ST
Practice Address - Street 2:
Practice Address - City:WABASSO
Practice Address - State:MN
Practice Address - Zip Code:56293-0060
Practice Address - Country:US
Practice Address - Phone:507-342-5519
Practice Address - Fax:507-342-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport