Provider Demographics
NPI:1467593129
Name:CITY OF BURLINGTON
Entity Type:Organization
Organization Name:CITY OF BURLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TREXEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-753-8396
Mailing Address - Street 1:400 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5515
Mailing Address - Country:US
Mailing Address - Phone:319-753-8396
Mailing Address - Fax:319-754-9545
Practice Address - Street 1:418 VALLEY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5515
Practice Address - Country:US
Practice Address - Phone:319-753-8396
Practice Address - Fax:319-754-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2290100IA341600000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014415Medicaid
IA01441OtherWELLMARK
IL37-1230188OtherILLINOIS MEDICAID
IA590043365OtherRAILROAD MEDICARE
IA01441Medicare PIN