Provider Demographics
NPI:1285794578
Name:ZUMBROTA AREA AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:ZUMBROTA AREA AMBULANCE ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-732-7845
Mailing Address - Street 1:1450 JEFFERSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992
Mailing Address - Country:US
Mailing Address - Phone:507-732-7845
Mailing Address - Fax:507-732-5060
Practice Address - Street 1:1450 JEFFERSON DRIVE
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992
Practice Address - Country:US
Practice Address - Phone:507-732-7845
Practice Address - Fax:507-732-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18913416A0800X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN131767900Medicaid
MN31480ZUOtherBLUE CROSS BLUE SHIELD
MN31480ZUOtherBLUE CROSS BLUE SHIELD