MEDICARE: SOUTH ST. PAUL FIRE DEPARTMENT

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	341600000X	Ambulance	0234	MN

General Provider Information

NPI Number	:	1265659080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ST. PAUL FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	310 MARIE AVE
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-2013
Country	:	US
Telephone Number	:	651-554-3250
Fax Number	:	651-554-3251

Provider Business Practice Location Address
First Line	:	310 MARIE AVE
Second Line	:
City	:	SOUTH ST PAUL
State	:	MN
Zip	:	55075-2013
Country	:	US
Telephone Number	:	651-554-3250
Fax Number	:	651-554-3251

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	HARRY FRANK RUND
Credential	:
Telephone Number	:	651-554-3250

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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