MEDICARE: CLARA CITY AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	0050	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45774CL	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144285610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA CITY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 560
Second Line	:	215 NW 1ST STREET
City	:	CLARA CITY
State	:	MN
Zip	:	56222-0560
Country	:	US
Telephone Number	:	320-847-2140
Fax Number	:	320-847-2114

Provider Business Practice Location Address
First Line	:	215 NW 1ST STREET
Second Line	:
City	:	CLARA CITY
State	:	MN
Zip	:	56222-0560
Country	:	US
Telephone Number	:	320-847-2140
Fax Number	:	320-847-2114

Authorized Official
Title or Position	:	SR. ACCTING CLERK
Name	:	JUDY GOSSELING
Credential	:
Telephone Number	:	320-847-2140

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/22/2020

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Directions to “CLARA CITY AMBULANCE SERVICE ” Practice Location

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