Provider Demographics
NPI:1003920919
Name:CITY OF UNDERWOOD
Entity Type:Organization
Organization Name:CITY OF UNDERWOOD
Other - Org Name:UNDERWOOD RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARAMEDIC/FIREFIGHTER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PS
Authorized Official - Phone:712-310-1319
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7780
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:218 2ND ST
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:IA
Practice Address - Zip Code:51576-8013
Practice Address - Country:US
Practice Address - Phone:712-310-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16684Medicare PIN