City of Kerkhoven

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0122 Issued in MN

Legal business name

CITY OF KERKHOVEN

Practice address

202 9TH Street N
Kerkhoven, MN 56252

Phone

(218) 233-5658

NPI assigned

Dec 11, 2006

Organization subpart

No

Name

Thomas Dahl

Title

Director

Phone

(320) 264-2581

• Kerkhoven Ambulance Service Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 13, 2009.

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231804800000",
    "number": "1447310271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 364",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565610364",
            "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": "202 9TH STREET N",
            "city": "KERKHOVEN",
            "state": "MN",
            "postal_code": "56252",
            "telephone_number": "218-233-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF KERKHOVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2009-01-13",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "320-264-2581"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MN",
            "license": "0122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916024800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "45379KE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kerkhoven Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Independent School District #0775
• Elouise 'Ellie' A Knutson, MSW LICSW

• All providers in Kerkhoven, MN
• Land Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.