Provider Demographics
NPI:1003271065
Name:AVOCA VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:AVOCA VOLUNTEER FIRE DEPARTMENT
Other - Org Name:AVOCA FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC SAFETY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-343-2424
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:IA
Mailing Address - Zip Code:51521-0246
Mailing Address - Country:US
Mailing Address - Phone:712-343-2424
Mailing Address - Fax:712-343-2323
Practice Address - Street 1:212 W CROCKER ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:IA
Practice Address - Zip Code:51521-5065
Practice Address - Country:US
Practice Address - Phone:712-343-2424
Practice Address - Fax:712-343-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27801003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04526Medicare PIN