Provider Demographics
NPI:1073673463
Name:CITY OF POLK CITY
Entity Type:Organization
Organization Name:CITY OF POLK CITY
Other - Org Name:POLK CITY FIRE RESCUE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-984-6304
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:112 3RD ST
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-0034
Mailing Address - Country:US
Mailing Address - Phone:515-984-6233
Mailing Address - Fax:515-984-6792
Practice Address - Street 1:309 W. VAN DORN
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-0034
Practice Address - Country:US
Practice Address - Phone:515-984-6304
Practice Address - Fax:515-984-6792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF POLK CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
IA2771000341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0142760Medicaid
IAI2049Medicare PIN