Provider Demographics
NPI:1306826599
Name:BENNETT VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BENNETT VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-890-2350
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:IA
Mailing Address - Zip Code:52721
Mailing Address - Country:US
Mailing Address - Phone:563-890-2350
Mailing Address - Fax:
Practice Address - Street 1:145 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENNETT
Practice Address - State:IA
Practice Address - Zip Code:52721
Practice Address - Country:US
Practice Address - Phone:563-890-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0063446Medicaid
16418Medicare ID - Type Unspecified