Provider Demographics
NPI:1790855641
Name:CITY OF WOODBURY
Entity Type:Organization
Organization Name:CITY OF WOODBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-714-3521
Mailing Address - Street 1:8301 VALLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2320
Mailing Address - Country:US
Mailing Address - Phone:651-714-3500
Mailing Address - Fax:651-714-3501
Practice Address - Street 1:2100 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9598
Practice Address - Country:US
Practice Address - Phone:651-714-3500
Practice Address - Fax:651-714-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN-02753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G268CIOtherBC BS OF MN
MN81-82027OtherMEDICA
MN111581OtherUCARE
MN036858001Medicaid
MN036858001Medicaid