Provider Demographics
NPI:1376039040
Name:CITY OF BENNETT
Entity Type:Organization
Organization Name:CITY OF BENNETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-890-2131
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:BENNETT
Mailing Address - State:IA
Mailing Address - Zip Code:52721-0045
Mailing Address - Country:US
Mailing Address - Phone:
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:563-890-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21605003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport