Blackduck Ambulance Association

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

BLACKDUCK AMBULANCE ASSOCIATION

Practice address

55 Railroad Avenue
Blackduck, MN 56630

Phone

(218) 835-4800

NPI assigned

Aug 16, 2006

Last updated

Apr 18, 2008By 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

Brent Sorensen

Title

Ambulance Manager

Phone

(218) 835-4800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208476800000",
    "number": "1932212693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 13TH AVE E",
            "address_2": "SUITE 6",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463675",
            "telephone_number": "218-263-7540",
            "fax_number": "866-732-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 RAILROAD AVENUE",
            "city": "BLACKDUCK",
            "state": "MN",
            "postal_code": "56630",
            "telephone_number": "218-835-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKDUCK AMBULANCE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-04-18",
        "status": "A",
        "authorized_official_last_name": "SORENSEN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "AMBULANCE MANAGER",
        "authorized_official_telephone_number": "218-835-4800"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6G209BL",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulance in Blackduck, MN
• Providers in Blackduck, MN by specialty
• Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; 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.