Healthcare Provider Details

I. General information

NPI: 1144285610
Provider Name (Legal Business Name): CLARA CITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NW 1ST STREET
CLARA CITY MN
56222-0560
US

IV. Provider business mailing address

PO BOX 560 215 NW 1ST STREET
CLARA CITY MN
56222-0560
US

V. Phone/Fax

Practice location:
  • Phone: 320-847-2140
  • Fax: 320-847-2114
Mailing address:
  • Phone: 320-847-2140
  • Fax: 320-847-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0050
License Number StateMN

VIII. Authorized Official

Name: JUDY GOSSELING
Title or Position: SR. ACCTING CLERK
Credential:
Phone: 320-847-2140