Provider Demographics
NPI:1982692141
Name:CITY OF WINDOM AMBULANCE
Entity Type:Organization
Organization Name:CITY OF WINDOM AMBULANCE
Other - Org Name:WINDOM AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-822-3774
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-0038
Mailing Address - Country:US
Mailing Address - Phone:507-831-2400
Mailing Address - Fax:507-831-5749
Practice Address - Street 1:444 9TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1641
Practice Address - Country:US
Practice Address - Phone:507-822-3774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9017140Medicaid
MN390768600Medicaid
IA0905059Medicaid
MN2E518WIOtherBLUE CROSS BLUE SHIELD