Provider Demographics
NPI:1235323874
Name:FREEBORN FIRE & AMBULANCE
Entity Type:Organization
Organization Name:FREEBORN FIRE & AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SEIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-863-2204
Mailing Address - Street 1:311 OAK ST
Mailing Address - Street 2:PO BOX 272
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1358
Mailing Address - Country:US
Mailing Address - Phone:651-463-3867
Mailing Address - Fax:651-460-6343
Practice Address - Street 1:402 PARK ST
Practice Address - Street 2:
Practice Address - City:FREEBORN
Practice Address - State:MN
Practice Address - Zip Code:56032-0099
Practice Address - Country:US
Practice Address - Phone:507-863-2204
Practice Address - Fax:507-863-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0385341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN176267200Medicaid