Provider Demographics
NPI:1689202624
Name:ST MARYS EMS
Entity Type:Organization
Organization Name:ST MARYS EMS
Other - Org Name:ESSENTIA HEALTH EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-5652
Mailing Address - Street 1:225 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3519
Mailing Address - Country:US
Mailing Address - Phone:218-847-0817
Mailing Address - Fax:218-844-0808
Practice Address - Street 1:225 PARK ST
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3519
Practice Address - Country:US
Practice Address - Phone:218-847-0817
Practice Address - Fax:218-844-0808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ESSENTIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport