Provider Demographics
NPI:1093765240
Name:PERCIVAL VOLUNTEER FIREMEN INCORPORATED
Entity Type:Organization
Organization Name:PERCIVAL VOLUNTEER FIREMEN INCORPORATED
Other - Org Name:PERCIVAL FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-374-2010
Mailing Address - Street 1:2530 BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:IA
Mailing Address - Zip Code:51640-5036
Mailing Address - Country:US
Mailing Address - Phone:712-374-2010
Mailing Address - Fax:712-529-4218
Practice Address - Street 1:2065 195TH AVE
Practice Address - Street 2:
Practice Address - City:PERCIVAL
Practice Address - State:IA
Practice Address - Zip Code:51648-6010
Practice Address - Country:US
Practice Address - Phone:712-374-2010
Practice Address - Fax:712-529-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23606003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA37529OtherBLUE CROSS BLUE SHIELD
IA0474528Medicaid
NE10025250300Medicaid
IA0474528Medicaid