MEDICARE: CITY OF MAHTOMEDI

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	0268	MN

General Provider Information

NPI Number	:	1295824126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MAHTOMEDI

Provider Business Mailing Address
First Line	:	600 STILLWATER RD
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115-2007
Country	:	US
Telephone Number	:	651-426-3344
Fax Number	:	651-426-1786

Provider Business Practice Location Address
First Line	:	800 STILLWATER RD
Second Line	:
City	:	MAHTOMEDI
State	:	MN
Zip	:	55115
Country	:	US
Telephone Number	:	651-426-1080
Fax Number	:	651-426-1786

Authorized Official
Title or Position	:	CITY ADMINISTRATOR
Name	:	MR. SCOTT DAVID NEILSON
Credential	:
Telephone Number	:	651-426-3344

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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Directions to “CITY OF MAHTOMEDI ” Practice Location

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