Provider Demographics
NPI:1417142480
Name:REGION XII COUNCIL OF GOVERNMENTS, INC.
Entity Type:Organization
Organization Name:REGION XII COUNCIL OF GOVERNMENTS, INC.
Other - Org Name:WESTERN IOWA TRANSIT SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRANSIT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-792-9914
Mailing Address - Street 1:1009 E ANTHONY ST
Mailing Address - Street 2:P.O. BOX 768
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3842
Mailing Address - Country:US
Mailing Address - Phone:712-792-9914
Mailing Address - Fax:712-792-1751
Practice Address - Street 1:1009 E ANTHONY ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3842
Practice Address - Country:US
Practice Address - Phone:712-792-9914
Practice Address - Fax:712-792-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0134742Medicaid