Provider Demographics
NPI:1033112669
Name:CITY OF LA PORTE CITY
Entity Type:Organization
Organization Name:CITY OF LA PORTE CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-342-2232
Mailing Address - Street 1:202 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-1234
Mailing Address - Country:US
Mailing Address - Phone:319-342-2232
Mailing Address - Fax:319-342-3770
Practice Address - Street 1:202 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1234
Practice Address - Country:US
Practice Address - Phone:319-342-2232
Practice Address - Fax:319-342-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20706003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00390OtherPRIVATE INSURANCE CO'S
IA0458661Medicaid
IAI12613OtherPTAN
IA0039008Medicaid
IA0458661Medicaid