Healthcare Provider Details

I. General information

NPI: 1245302371
Provider Name (Legal Business Name): CITY OF NEW PRAGUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL AVE N
NEW PRAGUE MN
56071-1534
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 952-758-4401
  • Fax:
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0174
License Number StateMN

VIII. Authorized Official

Name: JERRY BOHNSACK
Title or Position: CITY ADMINISTRATOR
Credential:
Phone: 952-758-4401