Provider Demographics
NPI:1992723944
Name:CITY OF BIWABIK
Entity type:Organization
Organization Name:CITY OF BIWABIK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-865-4183
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:866-732-0699
Practice Address - Street 1:103 3RD AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:BIWABIK
Practice Address - State:MN
Practice Address - Zip Code:55708-0529
Practice Address - Country:US
Practice Address - Phone:218-865-4183
Practice Address - Fax:218-865-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0027341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN382768200Medicaid
MN70215CIOtherBCBS
MN590047091Medicare PIN
MN70215CIOtherBCBS