Provider Demographics
NPI:1235284985
Name:TRI-COUNTY EMERGENCY MEDICAL SERVICES DISTRICT, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY EMERGENCY MEDICAL SERVICES DISTRICT, INC.
Other - Org Name:TRI-COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-436-3161
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:KARLSTAD
Mailing Address - State:MN
Mailing Address - Zip Code:56732-0216
Mailing Address - Country:US
Mailing Address - Phone:218-436-3161
Mailing Address - Fax:218-436-3162
Practice Address - Street 1:104 1ST ST S
Practice Address - Street 2:
Practice Address - City:KARLSTAD
Practice Address - State:MN
Practice Address - Zip Code:56732
Practice Address - Country:US
Practice Address - Phone:218-436-3161
Practice Address - Fax:218-436-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0120341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN170035OtherUCARE
MN63884TROtherBLUE CROSS BLUE SHIELD
MN012867800Medicaid
MN590000072Medicare UPIN
MN63884TROtherBLUE CROSS BLUE SHIELD