Provider Demographics
NPI:1881764041
Name:SPRING GROVE AMBULANCE CORPORATION
Entity type:Organization
Organization Name:SPRING GROVE AMBULANCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-459-1948
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974-0122
Mailing Address - Country:US
Mailing Address - Phone:507-498-3098
Mailing Address - Fax:
Practice Address - Street 1:192 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974-1444
Practice Address - Country:US
Practice Address - Phone:507-498-3098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN39737SPOtherBLUE PLUS
MN39737SPOtherBCBS
MN761367900OtherMHCP
MN761367900OtherMHCP