=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659397164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYO CLINIC AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 03/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 6TH AVE NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-281-1226
-----------------------------------------------------
Fax | 507-288-9004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 6TH AVE NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-281-1226
-----------------------------------------------------
Fax | 507-288-9004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. PAUL DRUCKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-255-7955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 0208
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------