Healthcare Provider Details

I. General information

NPI: 1629192422
Provider Name (Legal Business Name): CITY OF WINNEBAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH MAIN
WINNEBAGO MN
56098-0035
US

IV. Provider business mailing address

140 MAIN SOUTH PO BOX 35
WINNEBAGO MN
56098-0035
US

V. Phone/Fax

Practice location:
  • Phone: 507-893-3217
  • Fax: 507-893-3473
Mailing address:
  • Phone: 507-893-3217
  • Fax: 507-893-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number0271
License Number StateMN

VIII. Authorized Official

Name: RICHARD CHARLES MAURIS
Title or Position: AMBULANCE BILLING DEPARTMENT
Credential:
Phone: 507-893-3217