City of Littlefork

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0139 Issued in MN

Legal business name

CITY OF LITTLEFORK

Doing business as

Littlefork Ambulance

Practice address

901 Main St
Littlefork, MN 56653-9357

Phone

(218) 233-5658

Fax

(218) 233-7630

NPI assigned

Dec 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Fairchild

Title

City Administrator

Phone

(218) 278-6710

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Littlefork Ambulance Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003976390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MAIN ST",
            "city": "LITTLEFORK",
            "state": "MN",
            "postal_code": "566539357",
            "telephone_number": "218-233-5658",
            "fax_number": "218-233-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MAIN ST",
            "city": "LITTLEFORK",
            "state": "MN",
            "postal_code": "566539357",
            "telephone_number": "218-233-5658",
            "fax_number": "218-233-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF LITTLEFORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAIRCHILD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CITY ADMINISTRATOR",
        "authorized_official_telephone_number": "218-278-6710"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MN",
            "license": "0139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "45337LI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Littlefork Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristi Lynn Benedict, M.A. CCC-SLP
• Nicole Marie Busch, FNP-BC
• Heidi Christensen, B.S. LADC
• Betty J Ewald, PT
• Cynthia Lee Gudahl, LADC
• Paul David Havens, MD
• Ind School Dist 362
• International Falls Memorial Hospital Association (Rainy Lake Medical Center)

• Land Ambulance in Littlefork, MN
• Providers in Littlefork, MN by specialty
• Land Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.