Provider Demographics
NPI:1477613768
Name:CITY OF CANNON FALLS
Entity Type:Organization
Organization Name:CITY OF CANNON FALLS
Other - Org Name:CANNON FALLS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-263-9360
Mailing Address - Street 1:918 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CANNON FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:55009-1447
Mailing Address - Country:US
Mailing Address - Phone:507-263-9300
Mailing Address - Fax:507-263-2634
Practice Address - Street 1:918 RIVER RD
Practice Address - Street 2:
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-1447
Practice Address - Country:US
Practice Address - Phone:218-233-5658
Practice Address - Fax:218-233-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN323067800Medicaid
MN31023AMOtherBLUE CROSS BLUE SHIELD