Healthcare Provider Details

I. General information

NPI: 1356457212
Provider Name (Legal Business Name): CITY OF SAINT PAUL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 6TH ST
SAINT PAUL NE
68873-2015
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-4019
  • Fax: 402-965-8594
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-965-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1278
License Number StateNE

VIII. Authorized Official

Name: JACQUELINE MAYBERRY
Title or Position: RESCUE CLERK
Credential:
Phone: 402-572-4019