Provider Demographics
NPI:1174664957
Name:CITY OF WAUKEE
Entity Type:Organization
Organization Name:CITY OF WAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOISTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-987-4522
Mailing Address - Street 1:230 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5004
Mailing Address - Country:US
Mailing Address - Phone:515-987-4522
Mailing Address - Fax:
Practice Address - Street 1:230 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-5004
Practice Address - Country:US
Practice Address - Phone:515-987-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0232413Medicaid
IA42879OtherWELLMARK BC BS NUMBER
IA0232413Medicaid
IAI1587Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER