Provider Demographics
NPI:1194945071
Name:CITY OF BUFFALO LAKE
Entity type:Organization
Organization Name:CITY OF BUFFALO LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHAMLZ
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:320-833-5811
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:BUFFALO LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55314-0094
Mailing Address - Country:US
Mailing Address - Phone:320-833-5811
Mailing Address - Fax:320-833-2344
Practice Address - Street 1:323 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO LAKE
Practice Address - State:MN
Practice Address - Zip Code:55314-0094
Practice Address - Country:US
Practice Address - Phone:320-833-5811
Practice Address - Fax:320-833-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0039341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47046BUOtherBCBS
MN591067600OtherSENTRY CLAIMS SERVICES
MN591067600OtherHARTFORD INSURANCE
MNM491067600Medicaid
MN8180514OtherMEDICA
MN040624003OtherPRIME WEST