Provider Demographics
NPI:1114096591
Name:TOWN OF PAULLINA
Entity Type:Organization
Organization Name:TOWN OF PAULLINA
Other - Org Name:PAULLINA AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-949-3428
Mailing Address - Street 1:127 SOUTH MAIN
Mailing Address - Street 2:P.O. BOX 239
Mailing Address - City:PAULLINA
Mailing Address - State:IA
Mailing Address - Zip Code:51046-0239
Mailing Address - Country:US
Mailing Address - Phone:712-949-3428
Mailing Address - Fax:712-949-3499
Practice Address - Street 1:219 W. COMMERCE
Practice Address - Street 2:
Practice Address - City:PAULLINA
Practice Address - State:IA
Practice Address - Zip Code:51046-0239
Practice Address - Country:US
Practice Address - Phone:712-949-3428
Practice Address - Fax:712-949-3499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF PAULLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2710300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA128603Medicaid
IA12860Medicare ID - Type UnspecifiedPAULLINA AMBULANCE SERV