Provider Demographics
NPI:1659312890
Name:CITY OF HOYT LAKES
Entity Type:Organization
Organization Name:CITY OF HOYT LAKES
Other - Org Name:HOYT LAKES FIRE DEPT AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-225-2344
Mailing Address - Street 1:206 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOYT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55750-1150
Mailing Address - Country:US
Mailing Address - Phone:218-225-2344
Mailing Address - Fax:218-225-2485
Practice Address - Street 1:123 1/2 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOYT LAKES
Practice Address - State:MN
Practice Address - Zip Code:55750-1150
Practice Address - Country:US
Practice Address - Phone:218-225-2110
Practice Address - Fax:218-225-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN81-82306OtherMEDICA PROVIDER ID
MN81-80567OtherMEDICA PROVIDER ID
MN110513OtherUCARE PROVIDER ID
MN73474CIOtherBCBS PROVIDER ID
MN81-80567OtherMEDICA PROVIDER ID