=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770580664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF FAIRFAX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 09/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 1ST STREET SE
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55332-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-426-7255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 SE 1ST STREET
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55332-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-426-7255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR
-----------------------------------------------------
Name | KEVIN SCHAFER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-426-7255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 1898
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------