Active NPI
City of Raymond
Doing business as Raymond Ambulance Service
- Land Ambulance
- Raymond, MN
National Provider Identifier
1891907697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- CITY OF RAYMOND
- Doing business as
- Raymond Ambulance Service
- Practice address
- 314 Spicer Street
Raymond, MN 56282-9998 - Phone
- (320) 967-4226
- NPI assigned
- May 4, 2007
- Last updated
- Mar 14, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Diane Tallackson
- Title
- Claims Manager
- Phone
- (651) 653-2201
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | MN | Primary |
Addresses
Primary practice location
314 Spicer Street
Raymond, MN 56282-9998
Mailing address
PO Box 216
Raymond, MN 56282-0216
Phone (651) 653-2201
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 986313300 | Medicaid | MN | |
| BCBS | Other | MN | 45656RA |
Other names 1
- Raymond Ambulance Service
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130301000126 | MN | Part B Supplier - Ambulance Service Supplier | 1951556695 | Practice locations: Raymond, MN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1363219200000",
"number": "1891907697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 216",
"city": "RAYMOND",
"state": "MN",
"postal_code": "562820216",
"telephone_number": "651-653-2201",
"fax_number": "651-653-2213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 SPICER STREET",
"city": "RAYMOND",
"state": "MN",
"postal_code": "562829998",
"telephone_number": "320-967-4226"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CITY OF RAYMOND",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-04",
"last_updated": "2013-03-14",
"status": "A",
"authorized_official_last_name": "TALLACKSON",
"authorized_official_first_name": "DIANE",
"authorized_official_title_or_position": "CLAIMS MANAGER",
"authorized_official_telephone_number": "651-653-2201"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "986313300",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "45656RA",
"identifier": "BCBS",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Raymond Ambulance Service",
"code": "3",
"type": "Doing Business As"
}
]
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.