Provider Demographics
NPI:1033295910
Name:CITY OF ATWATER
Entity type:Organization
Organization Name:CITY OF ATWATER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:VEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-974-3351
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:MN
Mailing Address - Zip Code:56209-0457
Mailing Address - Country:US
Mailing Address - Phone:320-974-8000
Mailing Address - Fax:
Practice Address - Street 1:107 2ND AVE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:MN
Practice Address - Zip Code:56209
Practice Address - Country:US
Practice Address - Phone:329-974-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2G276ATOtherBLUE CROSS/BLUE SHIELD
81-81590OtherMEDICA