Provider Demographics
NPI:1689672628
Name:CITY OF CHATFIELD
Entity Type:Organization
Organization Name:CITY OF CHATFIELD
Other - Org Name:CHATFIELD AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/TRAINING COORDINATOR.
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-867-4446
Mailing Address - Street 1:21 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1204
Mailing Address - Country:US
Mailing Address - Phone:507-867-4446
Mailing Address - Fax:507-867-9093
Practice Address - Street 1:21 2ND ST SE
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1204
Practice Address - Country:US
Practice Address - Phone:507-867-4446
Practice Address - Fax:507-867-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0047341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39162CHOtherBLUE CROSS BLUE SHIELD MN
MN129611OtherUCARE MINNESOTA
MN402267000Medicaid
MN402267000Medicaid