Healthcare Provider Details

I. General information

NPI: 1992906960
Provider Name (Legal Business Name): CITY OF JEFFERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S DEAVER AVE
JEFFERS MN
56145
US

IV. Provider business mailing address

PO BOX 237
JEFFERS MN
56145
US

V. Phone/Fax

Practice location:
  • Phone: 507-628-4242
  • Fax: 507-628-4210
Mailing address:
  • Phone: 507-628-4242
  • Fax: 507-628-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number8203706
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. MORGEN M PEDERSON
Title or Position: DIRECTOR
Credential: EMT
Phone: 507-628-5533