Organization
MARINE ON ST CROIX AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE TALLACKSON (CLAIMS MANAGER)
(651) 653-2201
Entity
Organization
Contact information
Practice address
121 JUDD STREET, MARINE ON ST CROIX, MN 55047
(651) 433-3636
Mailing address
PO BOX 250, MARINE ON SAINT CROIX, MN 55047-0250
(651) 433-3636
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCBS
52584C1
MN
Enumeration date
05/04/2007
Last updated
09/28/2007
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