Healthcare Provider Details

I. General information

NPI: 1649558495
Provider Name (Legal Business Name): COUNTY OF CARLTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 N 11TH ST
CLOQUET MN
55720-1607
US

IV. Provider business mailing address

14 N 11TH ST PO BOX 660
CLOQUET MN
55720-1607
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-4583
  • Fax: 218-879-2500
Mailing address:
  • Phone: 218-879-4583
  • Fax: 218-879-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID LEE
Title or Position: DIRECTOR
Credential:
Phone: 218-879-4511