City of Stephen
Organization Active NPI Land Ambulance · Stephen, MN
NPI 1902965627 · NPPES record last updated Nov 27, 2013
Key facts
- NPI
- 1902965627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 17741 (MN)
- Legal business name
- CITY OF STEPHEN
- Practice address
- 846 5TH Street
Stephen, MN 56757-0289 - Phone
- (218) 478-3864
- NPI assigned
- Dec 8, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CITY OF STEPHEN
Authorized official
- Name
- Mr. Roger Nelson
- Title
- City Clerk
- Phone
- (218) 478-3614
Corporate family (same tax ID) 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131022000585 | MN | Part B Supplier - Ambulance Service Supplier | 9032344312 | Practice locations: Stephen, MN |
National Provider Directory
- Tax ID family
- City of Stephen
- Part of
- City of Stephen
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 17741 | MN | Yes |
Addresses
Primary practice location
846 5TH Street
Stephen, MN 56757-0289
Mailing address
PO Box 630
Stephen, MN 56757-0630
Phone (218) 478-3614
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 170709 | Other | MN | BLUE CROSS BLUE SHIELD-MN |
| 093867000 | Medicaid | MN |
Other names
- Stephen Volunteer Ambulance Service
Other providers in Stephen, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.