Provider Demographics
NPI:1568522852
Name:VILLAGE OF ASHBY
Entity Type:Organization
Organization Name:VILLAGE OF ASHBY
Other - Org Name:ASHBY FIRE DEPARTMENT AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZLOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-948-2655
Mailing Address - Street 1:203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MN
Mailing Address - Zip Code:56309-4662
Mailing Address - Country:US
Mailing Address - Phone:218-233-5658
Mailing Address - Fax:218-233-7630
Practice Address - Street 1:203 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MN
Practice Address - Zip Code:56309-4662
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:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62051ASOtherBLUE CROSS BLUE SHIELD