Healthcare Provider Details

I. General information

NPI: 1285665794
Provider Name (Legal Business Name): CITY OF SAUK CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SOUTH OAK STREET
SAUK CENTRE MN
56378
US

IV. Provider business mailing address

320 SOUTH OAK STREET
SAUK CENTRE MN
56378
US

V. Phone/Fax

Practice location:
  • Phone: 651-653-2201
  • Fax: 651-653-2213
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 State

VIII. Authorized Official

Name: MRS. DIANE L TALLACKSON
Title or Position: BILLING MANGER
Credential:
Phone: 651-653-2201