Provider Demographics
NPI:1134323264
Name:CITY OF LANESBORO
Entity Type:Organization
Organization Name:CITY OF LANESBORO
Other - Org Name:AMBULANCE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:TORGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-467-3722
Mailing Address - Street 1:202 PARKWAY AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:LANESBORO
Mailing Address - State:MN
Mailing Address - Zip Code:55949
Mailing Address - Country:US
Mailing Address - Phone:507-467-3722
Mailing Address - Fax:507-467-2557
Practice Address - Street 1:202 PARKWAY AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:LANESBORO
Practice Address - State:MN
Practice Address - Zip Code:55949
Practice Address - Country:US
Practice Address - Phone:507-467-3722
Practice Address - Fax:507-467-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN360867100Medicaid
MN39780LAOtherBCBS ID
MN590000067Medicare ID - Type UnspecifiedAMBULANCE