Provider Demographics
NPI:1376595678
Name:TOWN OF BLOCKTON
Entity Type:Organization
Organization Name:TOWN OF BLOCKTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-788-2655
Mailing Address - Street 1:405 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BLOCKTON
Mailing Address - State:IA
Mailing Address - Zip Code:50836-2066
Mailing Address - Country:US
Mailing Address - Phone:641-788-2655
Mailing Address - Fax:641-788-2655
Practice Address - Street 1:304 DIVISION STREET
Practice Address - Street 2:
Practice Address - City:BLOCKTON
Practice Address - State:IA
Practice Address - Zip Code:50836-2066
Practice Address - Country:US
Practice Address - Phone:641-788-2655
Practice Address - Fax:641-788-2655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF BLOCKTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0138909Medicaid
IA13890Medicare ID - Type Unspecified