Provider Demographics
NPI:1033303235
Name:CITY OF DUMONT
Entity Type:Organization
Organization Name:CITY OF DUMONT
Other - Org Name:DUMONT VOLUNTEER AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREW CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-857-6257
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-991-0719
Practice Address - Street 1:630 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:IA
Practice Address - Zip Code:50625-7704
Practice Address - Country:US
Practice Address - Phone:641-857-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2120800146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0160754Medicaid
IA16075Medicare UPIN