Provider Demographics
NPI:1073711545
Name:CITY OF MADELIA
Entity Type:Organization
Organization Name:CITY OF MADELIA
Other - Org Name:MADELIA COMMUNITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-642-3245
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1440
Mailing Address - Country:US
Mailing Address - Phone:507-642-3245
Mailing Address - Fax:507-642-8556
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1440
Practice Address - Country:US
Practice Address - Phone:507-642-3245
Practice Address - Fax:507-642-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN42361MAOtherBLUE CROSS BLUE SHIELD