Provider Demographics
NPI:1346792371
Name:MIDWEST MEDICAL TRANSPORT COMPANY, LLC-DBA SOUTHEAST IOWA AMBULANCE
Entity Type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORT COMPANY, LLC-DBA SOUTHEAST IOWA AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-720-8199
Mailing Address - Street 1:4165 NAPLES AVE SW STE 5
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-8626
Mailing Address - Country:US
Mailing Address - Phone:319-466-0736
Mailing Address - Fax:319-466-0740
Practice Address - Street 1:2155 33RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3148
Practice Address - Country:US
Practice Address - Phone:402-562-6430
Practice Address - Fax:402-563-0937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST MEDICAL TRANSPORT COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2001400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1871991125Medicaid
IA1871991125Medicaid