Provider Demographics
NPI:1255470332
Name:CITY OF BLOOMING PRAIRIE
Entity Type:Organization
Organization Name:CITY OF BLOOMING PRAIRIE
Other - Org Name:BLOOMING PRAIRIE AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY CITY CLERK TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:CLEONE
Authorized Official - Last Name:MOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-583-7573
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:BLOOMING PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55917
Mailing Address - Country:US
Mailing Address - Phone:507-583-7573
Mailing Address - Fax:507-583-4520
Practice Address - Street 1:333 2ND AVENUE NE
Practice Address - Street 2:
Practice Address - City:BLOOMING PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55917
Practice Address - Country:US
Practice Address - Phone:507-583-7573
Practice Address - Fax:507-583-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014914OtherRAILROAD MEDICARE
MN167883OtherUCARE MINNESOTA
MN493267600Medicaid
MN35019BLOtherBLUE CROSS
MN167883OtherUCARE MINNESOTA