Organization
RED LAKE FALLS VOLUNTEER AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE TALLACKSON (CLAIMS MANAGER)
(651) 653-2201
Entity
Organization
Contact information
Practice address
201 CHAMPAGNE AVE SW, RED LAKE FALLS, MN 56750-4003
(651) 653-2201
Mailing address
PO BOX 194, RED LAKE FALLS, MN 56750-0194
(651) 653-2201
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
491567400
—
MN
01
—
63663RE
BCBS
MN
Enumeration date
05/01/2007
Last updated
12/04/2013
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