MEDICARE: CITY OF ST. CHARLES

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	0214	MN

General Provider Information

NPI Number	:	1619179801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ST. CHARLES

Provider Business Mailing Address
First Line	:	830 WHITEWATER AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MN
Zip	:	55972-1129
Country	:	US
Telephone Number	:	507-932-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 WHITEWATER AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MN
Zip	:	55972-1129
Country	:	US
Telephone Number	:	507-932-3020
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTANT
Name	:	KRISTINE KAY HUINKER
Credential	:
Telephone Number	:	507-932-3020

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	06/25/2008

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Directions to “CITY OF ST. CHARLES ” Practice Location

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