Provider Demographics
NPI:1033178959
Name:TOWN OF BELLEVUE
Entity Type:Organization
Organization Name:TOWN OF BELLEVUE
Other - Org Name:CITY OF BELLEVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CITY CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-872-4456
Mailing Address - Street 1:106 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031-1260
Mailing Address - Country:US
Mailing Address - Phone:563-872-4456
Mailing Address - Fax:563-872-4094
Practice Address - Street 1:204 N 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-1931
Practice Address - Country:US
Practice Address - Phone:563-872-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074757Medicaid
IA0074757Medicaid