Provider Demographics
NPI:1003887316
Name:CITY OF PRAIRIE CITY
Entity Type:Organization
Organization Name:CITY OF PRAIRIE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN DER KAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-994-2649
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:203 E. JEFFERSON ST.
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50228-0607
Mailing Address - Country:US
Mailing Address - Phone:515-994-2649
Mailing Address - Fax:515-994-2376
Practice Address - Street 1:203 E. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:PRAIRIE CITY
Practice Address - State:IA
Practice Address - Zip Code:50228-0607
Practice Address - Country:US
Practice Address - Phone:515-994-2649
Practice Address - Fax:515-994-2376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF PRAIRIE CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2500500341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0022129Medicaid
IA02212Medicare ID - Type Unspecified