Provider Demographics
NPI:1033265228
Name:CITY OF GRUNDY CENTER
Entity Type:Organization
Organization Name:CITY OF GRUNDY CENTER
Other - Org Name:GRUNDY CENTER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-825-5480
Mailing Address - Street 1:507 F AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638
Mailing Address - Country:US
Mailing Address - Phone:319-825-5480
Mailing Address - Fax:319-825-6073
Practice Address - Street 1:507 F AVENUE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638
Practice Address - Country:US
Practice Address - Phone:319-825-5480
Practice Address - Fax:319-825-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23448Medicare ID - Type Unspecified