Provider Demographics
NPI:1194859124
Name:CITY OF CLOQUET
Entity Type:Organization
Organization Name:CITY OF CLOQUET
Other - Org Name:CLOQUET AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-879-3347
Mailing Address - Street 1:1307 CLOQUET AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1656
Mailing Address - Country:US
Mailing Address - Phone:218-879-3347
Mailing Address - Fax:218-879-6555
Practice Address - Street 1:508 CLOQUET AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-3742
Practice Address - Country:US
Practice Address - Phone:218-879-6514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120910OtherUCARE MN
MN75095CLOtherFIRST PLAN
MN8180850Medicaid
MN75095CLOtherBCBS OF MN