Provider Demographics
NPI:1407804263
Name:CITY OF JASPER
Entity Type:Organization
Organization Name:CITY OF JASPER
Other - Org Name:JASPER COMMUNITY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:507-825-6770
Mailing Address - Street 1:101 WALL ST W
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:MN
Mailing Address - Zip Code:56144-1143
Mailing Address - Country:US
Mailing Address - Phone:507-648-3701
Mailing Address - Fax:507-348-3000
Practice Address - Street 1:101 WALL ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:MN
Practice Address - Zip Code:56144-1102
Practice Address - Country:US
Practice Address - Phone:507-348-3701
Practice Address - Fax:507-348-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0118341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance