Basic Information
| Provider Information | |||||||||
| NPI: | 1205056744 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CITY OF BABBITT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BABBITT AMBULANCE SERVICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183626683 | ||||||||
| FaxNumber: | 2183626684 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 SOUTH DR | ||||||||
| Address2: | |||||||||
| City: | BABBITT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557061232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183626683 | ||||||||
| FaxNumber: | 2183626684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 01/31/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARINARO | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2183626683 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | MN | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 481367700 | 05 | MN | MEDICAID | 69021BA | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 791590627 | 01 | MN | RAILROAD MEDICARE | OTHER |