=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235323874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEBORN FIRE & AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 07/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 PARK ST
-----------------------------------------------------
City | FREEBORN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56032-0099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-863-2204
-----------------------------------------------------
Fax | 507-863-2521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 OAK ST PO BOX 272
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55024-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-463-3867
-----------------------------------------------------
Fax | 651-460-6343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY TREASURER
-----------------------------------------------------
Name | VALERIE KAY SEIPP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-863-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 0385
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------