Provider Demographics
NPI:1114914819
Name:COUNTY OF MADISON
Entity Type:Organization
Organization Name:COUNTY OF MADISON
Other - Org Name:MADISON COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TADD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-462-2253
Mailing Address - Street 1:1008 N JOHN WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-1233
Mailing Address - Country:US
Mailing Address - Phone:515-462-2253
Mailing Address - Fax:515-462-2255
Practice Address - Street 1:1008 N JOHN WAYNE DR
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1233
Practice Address - Country:US
Practice Address - Phone:515-462-2253
Practice Address - Fax:515-462-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201996Medicaid
IA03189Medicare ID - Type UnspecifiedAMBULANCE