MEDICARE: CITY OF WABASSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	0253	MN

General Provider Information

NPI Number	:	1073634291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WABASSO

Provider Business Mailing Address
First Line	:	1225 OAK ST
Second Line	:	P O BOX 60
City	:	WABASSO
State	:	MN
Zip	:	56293-0060
Country	:	US
Telephone Number	:	507-342-5519
Fax Number	:	507-342-2213

Provider Business Practice Location Address
First Line	:	1225 OAK ST
Second Line	:
City	:	WABASSO
State	:	MN
Zip	:	56293-0060
Country	:	US
Telephone Number	:	507-342-5519
Fax Number	:	507-342-2213

Authorized Official
Title or Position	:	CITY CLERKTREASURER
Name	:	MARY K. SMITH
Credential	:
Telephone Number	:	507-342-5519

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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Directions to “CITY OF WABASSO ” Practice Location

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