# MARINE ON ST CROIX AMBULANCE SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346452141
- **Authorized official:** DIANE TALLACKSON (CLAIMS MANAGER)
- **Authorized official phone:** (651) 653-2201

## Contact information

- **Practice address:** 121 JUDD STREET, MARINE ON ST CROIX, MN 55047
- **Practice address phone:** (651) 433-3636
- **Mailing address:** PO BOX 250, MARINE ON SAINT CROIX, MN 55047-0250
- **Mailing address phone:** (651) 433-3636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | MN | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 09/28/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | BCBS | 52584C1 | MN |