Provider Demographics
NPI:1417980475
Name:CITY WHITE BEAR LAKE
Entity Type:Organization
Organization Name:CITY WHITE BEAR LAKE
Other - Org Name:WHITE BEAR LAKE FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:SATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-429-8516
Mailing Address - Street 1:4701 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3227
Mailing Address - Country:US
Mailing Address - Phone:651-429-8526
Mailing Address - Fax:651-429-8500
Practice Address - Street 1:4701 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3227
Practice Address - Country:US
Practice Address - Phone:651-429-8526
Practice Address - Fax:651-429-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0267341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN651368900Medicaid
MN651368900Medicaid