Healthcare Provider Details

I. General information

NPI: 1396403424
Provider Name (Legal Business Name): CITY OF CHISHOLM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH AVE SE
CHISHOLM MN
55719-1000
US

IV. Provider business mailing address

316 W LAKE ST
CHISHOLM MN
55719-3708
US

V. Phone/Fax

Practice location:
  • Phone: 218-254-7902
  • Fax:
Mailing address:
  • Phone: 218-254-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEPHANIE MARIE SKRABA
Title or Position: CITY ADMINISTRATOR
Credential:
Phone: 218-254-7960