Provider Demographics
NPI:1053458521
Name:CITY OF SANBORN
Entity Type:Organization
Organization Name:CITY OF SANBORN
Other - Org Name:SANBORN COMMUNITY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-757-4305
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:102 MAIN ST.
Mailing Address - City:SANBORN
Mailing Address - State:IA
Mailing Address - Zip Code:51248-0548
Mailing Address - Country:US
Mailing Address - Phone:712-930-3842
Mailing Address - Fax:712-930-3060
Practice Address - Street 1:410 EAST FIRST ST.
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:IA
Practice Address - Zip Code:51248
Practice Address - Country:US
Practice Address - Phone:712-930-3842
Practice Address - Fax:712-930-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2710500341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0099150Medicaid
IA09915OtherBLUE CROSS BLUE SHIELD
IA0099150Medicaid