Provider Demographics
NPI:1811025158
Name:LOWER ST CROIX VALLEY FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LOWER ST CROIX VALLEY FIRE PROTECTION DISTRICT
Other - Org Name:LOWER ST. CROIX VALLEY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREMOND
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-436-7033
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-0234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1520 SAINT CROIX TRL S
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043-9311
Practice Address - Country:US
Practice Address - Phone:651-436-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173867400Medicaid
MN590013825OtherRAILROAD MEDICARE
MN27764CROtherBLUE CROSS BLUE SHIELD
MN173867400Medicaid