Provider Demographics
NPI:1497831705
Name:GUNFLINT TRAIL VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:GUNFLINT TRAIL VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:DAHL
Authorized Official - Last Name:POPKES
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:218-388-9491
Mailing Address - Street 1:7401 GUNFLINT TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-2022
Mailing Address - Country:US
Mailing Address - Phone:218-388-0314
Mailing Address - Fax:218-388-0102
Practice Address - Street 1:112 S GUNFLINT LK RD
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604
Practice Address - Country:US
Practice Address - Phone:218-388-0314
Practice Address - Fax:218-388-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN74539GUOtherBLUE CROSS BLUE SHIELD
81-50084OtherMEDICA