Provider Demographics
NPI:1154411205
Name:CITY OF LEWISTON
Entity type:Organization
Organization Name:CITY OF LEWISTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-523-2982
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MN
Mailing Address - Zip Code:55952-0722
Mailing Address - Country:US
Mailing Address - Phone:507-523-2257
Mailing Address - Fax:507-523-2306
Practice Address - Street 1:75 RICE STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MN
Practice Address - Zip Code:55952
Practice Address - Country:US
Practice Address - Phone:507-523-2257
Practice Address - Fax:507-523-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0135341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38250LEOtherBLUE CROSS BLUE SHIELD
MN773267800Medicaid
81380OtherMMSI
MN8182873OtherMEDICA
MN590013759OtherMEDICARE RAILROAD
170133OtherUCARE