Healthcare Provider Details

I. General information

NPI: 1003976838
Provider Name (Legal Business Name): CITY OF PRESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 FILLMORE ST W.
PRESTON MN
55965
US

IV. Provider business mailing address

P.O. BOX 657 210 FILLMORE ST W.
PRESTON MN
55965
US

V. Phone/Fax

Practice location:
  • Phone: 507-765-2153
  • Fax:
Mailing address:
  • Phone: 507-765-2153
  • Fax: 507-765-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0199
License Number StateMN

VIII. Authorized Official

Name: RYAN THROCKMORTON
Title or Position: DIRECTOR
Credential:
Phone: 507-765-2153