Provider Demographics
NPI:1306826359
Name:CITY OF WEST DES MOINES
Entity Type:Organization
Organization Name:CITY OF WEST DES MOINES
Other - Org Name:IOWA EMS ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUMERMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-222-3652
Mailing Address - Street 1:PO BOX 65320
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-0320
Mailing Address - Country:US
Mailing Address - Phone:515-222-3652
Mailing Address - Fax:515-273-0662
Practice Address - Street 1:8055 MILLS CIVIC PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-3815
Practice Address - Country:US
Practice Address - Phone:515-222-3652
Practice Address - Fax:515-273-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2771300146L00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0068056Medicaid
IA089832800OtherBLACK LUNG/FECA
IA806190609Medicaid
IA06805OtherWELLMARK BCBS
IA590043341Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IA806190609Medicaid