Basic Information
| Provider Information | |||||||||
| NPI: | 1720191984 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY EMERGENCY MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3920 13TH AVE E | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557463675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182637540 | ||||||||
| FaxNumber: | 8667320699 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 NORTH MILL STREET | ||||||||
| Address2: | |||||||||
| City: | FERTILE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189453110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | BELAU | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO OF AMBULANCE | ||||||||
| AuthorizedOfficialTelephone: | 2189453110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 224867100 | 05 | MN | MEDICAID | 63125CO | 01 | MN | BCBS | OTHER |