Provider Demographics
NPI:1649428632
Name:CITY OF CEYLON
Entity type:Organization
Organization Name:CITY OF CEYLON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:DITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-632-4653
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:P. O. BOX 328
Mailing Address - City:CEYLON
Mailing Address - State:MN
Mailing Address - Zip Code:56121-5002
Mailing Address - Country:US
Mailing Address - Phone:507-632-4653
Mailing Address - Fax:507-632-4653
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CEYLON
Practice Address - State:MN
Practice Address - Zip Code:56121-5002
Practice Address - Country:US
Practice Address - Phone:507-632-4653
Practice Address - Fax:507-632-4653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CEYLON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN03273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN345423100Medicaid
MN570000057Medicare PIN