Provider Demographics
NPI:1659397164
Name:MAYO CLINIC AMBULANCE
Entity Type:Organization
Organization Name:MAYO CLINIC AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-255-7955
Mailing Address - Street 1:501 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2673
Mailing Address - Country:US
Mailing Address - Phone:507-281-1226
Mailing Address - Fax:507-288-9004
Practice Address - Street 1:501 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2673
Practice Address - Country:US
Practice Address - Phone:507-281-1226
Practice Address - Fax:507-288-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN937318700Medicaid
MN115714100Medicaid
MN590012979OtherRAILROAD MEDICARE
MN211911100Medicaid
MN660717900Medicaid
MNP00131221OtherRAILROAD MEDICARE
MN590013327OtherRAILROAD MEDICARE
MN590014431OtherRAILROAD MEDICARE
MN562514900Medicaid
MN590012788OtherRAILROAD MEDICARE
MN590014430OtherRAILROAD MEDICARE
MN590014432OtherRAILROAD MEDICARE
MN590014433OtherRAILROAD MEDICARE
MN211911100Medicaid
MN115714100Medicaid