Provider Demographics
NPI:1033140272
Name:CITY OF SERGEANT BLUFF
Entity Type:Organization
Organization Name:CITY OF SERGEANT BLUFF
Other - Org Name:SERGEANT BLUFF FIRE & RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-943-5000
Mailing Address - Street 1:204 PORT NEAL ROAD
Mailing Address - Street 2:PO BOX 609
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-0609
Mailing Address - Country:US
Mailing Address - Phone:712-943-5000
Mailing Address - Fax:712-943-5006
Practice Address - Street 1:204 PORT NEAL ROAD
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-0000
Practice Address - Country:US
Practice Address - Phone:712-251-6923
Practice Address - Fax:712-943-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
IA2972300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15476OtherBCBS
IA0154765Medicaid
IA15476OtherBCBS