MEDICARE: CITY OF TOWER

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	3416L0300X	Land Ambulance	0244	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	69119TO	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1295951309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF TOWER

Provider Business Mailing Address
First Line	:	402 PINE STREET
Second Line	:
City	:	TOWER
State	:	MN
Zip	:	55790
Country	:	US
Telephone Number	:	218-753-4070
Fax Number	:	218-753-3020

Provider Business Practice Location Address
First Line	:	602 MAIN STREET
Second Line	:
City	:	TOWER
State	:	MN
Zip	:	55790
Country	:	US
Telephone Number	:	218-753-4070
Fax Number	:	218-753-3020

Authorized Official
Title or Position	:	CITY CLERK
Name	:	ANN LAMPPA
Credential	:
Telephone Number	:	218-753-4070

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/24/2008

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Directions to “CITY OF TOWER ” Practice Location

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