Provider Demographics
NPI:1255320420
Name:CITY OF TRAER
Entity Type:Organization
Organization Name:CITY OF TRAER
Other - Org Name:TRAER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:319-478-2084
Mailing Address - Street 1:649 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TRAER
Mailing Address - State:IA
Mailing Address - Zip Code:50675-1230
Mailing Address - Country:US
Mailing Address - Phone:319-478-2084
Mailing Address - Fax:319-478-2084
Practice Address - Street 1:649 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAER
Practice Address - State:IA
Practice Address - Zip Code:50675-1230
Practice Address - Country:US
Practice Address - Phone:319-478-2084
Practice Address - Fax:319-478-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2860700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0073700Medicaid
IA0073700Medicaid