Provider Demographics
NPI:1982814497
Name:CITY OF COOPERSTOWN
Entity Type:Organization
Organization Name:CITY OF COOPERSTOWN
Other - Org Name:COOPERSTOWN AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-797-3613
Mailing Address - Street 1:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-0712
Mailing Address - Country:US
Mailing Address - Phone:701-797-3613
Mailing Address - Fax:
Practice Address - Street 1:611 9TH ST. NE
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-0712
Practice Address - Country:US
Practice Address - Phone:701-797-3613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50502Medicaid
ND10538OtherBLUECROSS BLUESHIELD
ND50502Medicaid