Provider Demographics
NPI:1114142759
Name:CLINTON MUNICIPAL TRANSIT
Entity Type:Organization
Organization Name:CLINTON MUNICIPAL TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSIT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CULLINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-242-3721
Mailing Address - Street 1:1320 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5741
Mailing Address - Country:US
Mailing Address - Phone:563-242-3721
Mailing Address - Fax:563-242-3793
Practice Address - Street 1:1320 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5741
Practice Address - Country:US
Practice Address - Phone:563-242-3721
Practice Address - Fax:563-242-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0453696Medicaid