Provider Demographics
NPI:1225250491
Name:CLARA CITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CLARA CITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-847-2140
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:215 NW 1ST STREET
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56222-0560
Mailing Address - Country:US
Mailing Address - Phone:320-847-2142
Mailing Address - Fax:320-847-2114
Practice Address - Street 1:215 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:CLARA CITY
Practice Address - State:MN
Practice Address - Zip Code:56222-0560
Practice Address - Country:US
Practice Address - Phone:320-847-2142
Practice Address - Fax:320-847-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0050341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45774CLOtherBLUE CROSS BLUE SHIELD