Provider Demographics
NPI:1679511919
Name:CITY OF GAYLORD
Entity Type:Organization
Organization Name:CITY OF GAYLORD
Other - Org Name:GAYLORD AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-237-2338
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:866-732-0699
Practice Address - Street 1:328 MAIN AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MN
Practice Address - Zip Code:55334-0987
Practice Address - Country:US
Practice Address - Phone:507-237-2338
Practice Address - Fax:507-237-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN210868200Medicaid
MN53063GAOtherBCBS
MN210868200Medicaid
MN53063GAOtherBCBS