Provider Demographics
NPI:1295824126
Name:CITY OF MAHTOMEDI
Entity Type:Organization
Organization Name:CITY OF MAHTOMEDI
Other - Org Name:MAHTOMEDI FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NEILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-426-3344
Mailing Address - Street 1:600 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-2007
Mailing Address - Country:US
Mailing Address - Phone:651-426-3344
Mailing Address - Fax:651-426-1786
Practice Address - Street 1:800 STILLWATER RD
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115
Practice Address - Country:US
Practice Address - Phone:651-426-1080
Practice Address - Fax:651-426-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0268341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance