Healthcare Provider Details

I. General information

NPI: 1881764041
Provider Name (Legal Business Name): SPRING GROVE AMBULANCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 W MAIN ST
SPRING GROVE MN
55974-1444
US

IV. Provider business mailing address

PO BOX 122
SPRING GROVE MN
55974-0122
US

V. Phone/Fax

Practice location:
  • Phone: 507-498-3098
  • Fax:
Mailing address:
  • Phone: 507-498-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. HEATHER M GRAY
Title or Position: TREASURER
Credential:
Phone: 507-459-1948