Provider Demographics
NPI:1184653222
Name:CITY OF EVERLY
Entity Type:Organization
Organization Name:CITY OF EVERLY
Other - Org Name:EVERLY FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-834-2063
Mailing Address - Street 1:202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:51338-7729
Mailing Address - Country:US
Mailing Address - Phone:712-834-2063
Mailing Address - Fax:712-834-3063
Practice Address - Street 1:202 N MAIN
Practice Address - Street 2:
Practice Address - City:EVERLY
Practice Address - State:IA
Practice Address - Zip Code:51338-0197
Practice Address - Country:US
Practice Address - Phone:712-834-2063
Practice Address - Fax:712-834-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2210400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42820OtherBCBS
IA0233767Medicaid
IA0233767Medicaid
IAI4775Medicare PIN