Healthcare Provider Details

I. General information

NPI: 1891907697
Provider Name (Legal Business Name): CITY OF RAYMOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SPICER STREET
RAYMOND MN
56282-9998
US

IV. Provider business mailing address

PO BOX 216
RAYMOND MN
56282-0216
US

V. Phone/Fax

Practice location:
  • Phone: 320-967-4226
  • Fax:
Mailing address:
  • Phone: 651-653-2201
  • Fax: 651-653-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANE TALLACKSON
Title or Position: CLAIMS MANAGER
Credential:
Phone: 651-653-2201