Healthcare Provider Details

I. General information

NPI: 1649428632
Provider Name (Legal Business Name): CITY OF CEYLON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MAIN ST
CEYLON MN
56121-5002
US

IV. Provider business mailing address

301 W MAIN ST P. O. BOX 328
CEYLON MN
56121-5002
US

V. Phone/Fax

Practice location:
  • Phone: 507-632-4653
  • Fax: 507-632-4653
Mailing address:
  • Phone: 507-632-4653
  • Fax: 507-632-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0327
License Number StateMN

VIII. Authorized Official

Name: MR. WILLIAM F. DITZ
Title or Position: CLERK/TREASURER
Credential:
Phone: 507-632-4653