Provider Demographics
NPI:1316954415
Name:CITY OF EDINA
Entity type:Organization
Organization Name:CITY OF EDINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-826-0401
Mailing Address - Street 1:4801 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1330
Mailing Address - Country:US
Mailing Address - Phone:952-826-0414
Mailing Address - Fax:952-826-0390
Practice Address - Street 1:6250 TRACY AVE
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2554
Practice Address - Country:US
Practice Address - Phone:952-826-0330
Practice Address - Fax:952-826-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN074367400Medicaid
MN074367400Medicaid