Provider Demographics
NPI:1164505954
Name:TOWN OF GRANVILLE
Entity Type:Organization
Organization Name:TOWN OF GRANVILLE
Other - Org Name:GRANVILLE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-727-3365
Mailing Address - Street 1:740 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51022
Mailing Address - Country:US
Mailing Address - Phone:877-882-9911
Mailing Address - Fax:877-882-9922
Practice Address - Street 1:740 BROAD ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:IA
Practice Address - Zip Code:51022
Practice Address - Country:US
Practice Address - Phone:877-882-9911
Practice Address - Fax:877-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28408003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223768Medicaid
IA14804OtherBLUE CROSS/BLUE SHIELD
IA14804Medicare PIN