Provider Demographics
NPI:1477535870
Name:TOWN OF GLADBROOK
Entity Type:Organization
Organization Name:TOWN OF GLADBROOK
Other - Org Name:GLADBROOK-LINCOLN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-473-2281
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:GLADBROOK
Mailing Address - State:IA
Mailing Address - Zip Code:50635
Mailing Address - Country:US
Mailing Address - Phone:641-473-2281
Mailing Address - Fax:541-473-2281
Practice Address - Street 1:1254 HWY 96
Practice Address - Street 2:
Practice Address - City:GLADBROOK
Practice Address - State:IA
Practice Address - Zip Code:50635
Practice Address - Country:US
Practice Address - Phone:641-473-2281
Practice Address - Fax:641-473-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA86043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07446Medicare ID - Type UnspecifiedGLADBROOK-LINCOLN AMB. ID