Provider Demographics
NPI:1346382363
Name:COUNTY OF SAC
Entity Type:Organization
Organization Name:COUNTY OF SAC
Other - Org Name:SAC COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:712-662-4481
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-0121
Mailing Address - Country:US
Mailing Address - Phone:712-662-4481
Mailing Address - Fax:
Practice Address - Street 1:110 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-0121
Practice Address - Country:US
Practice Address - Phone:712-662-4481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2810300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0053900Medicaid
IA0053900Medicaid