Healthcare Provider Details

I. General information

NPI: 1033295910
Provider Name (Legal Business Name): CITY OF ATWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 2ND AVE
ATWATER MN
56209
US

IV. Provider business mailing address

PO BOX 457
ATWATER MN
56209-0457
US

V. Phone/Fax

Practice location:
  • Phone: 329-974-8000
  • Fax:
Mailing address:
  • Phone: 320-974-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0013
License Number StateMN

VIII. Authorized Official

Name: VEDA STOCKLAND
Title or Position: AMBULANCE SUPERVISOR
Credential:
Phone: 320-974-3351