Provider Demographics
NPI:1275675290
Name:TOWN OF SHELBY
Entity Type:Organization
Organization Name:TOWN OF SHELBY
Other - Org Name:SHELBY FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-544-2404
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:419 EAST STREET
Mailing Address - City:SHELBY
Mailing Address - State:IA
Mailing Address - Zip Code:51570
Mailing Address - Country:US
Mailing Address - Phone:712-544-2404
Mailing Address - Fax:712-544-2703
Practice Address - Street 1:402 CENTER ST
Practice Address - Street 2:BOX #6
Practice Address - City:SHELBY
Practice Address - State:IA
Practice Address - Zip Code:51570-3400
Practice Address - Country:US
Practice Address - Phone:712-544-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2830800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106419Medicaid
IA0106419Medicaid