Provider Demographics
NPI:1093896391
Name:ESTHERVILLE AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:ESTHERVILLE AMBULANCE SERVICE INC.
Other - Org Name:COMMUNITY AMBULANCE SERVICE INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:HAUKOOS
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:712-362-4221
Mailing Address - Street 1:15 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2101
Mailing Address - Country:US
Mailing Address - Phone:712-362-4221
Mailing Address - Fax:712-362-4221
Practice Address - Street 1:15 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2101
Practice Address - Country:US
Practice Address - Phone:712-362-4221
Practice Address - Fax:712-362-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPS-18-018-07146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0017426Medicaid
IA0017426Medicaid