Provider Demographics
NPI:1033110739
Name:CITY OF CLARENCE
Entity Type:Organization
Organization Name:CITY OF CLARENCE
Other - Org Name:CLARENCE COMMUNITY AMBULANCE ASSN.
Other - Org Type:Other Name
Authorized Official - Title/Position:ASST. COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-452-4440
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:IA
Mailing Address - Zip Code:52216-0367
Mailing Address - Country:US
Mailing Address - Phone:563-452-4440
Mailing Address - Fax:563-452-4368
Practice Address - Street 1:411 LOMBARD ST.
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:IA
Practice Address - Zip Code:52216
Practice Address - Country:US
Practice Address - Phone:563-452-4440
Practice Address - Fax:563-452-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2160700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421062575OtherFED ID#
IAY33454Medicare UPIN
IAI15054Medicare ID - Type Unspecified