Provider Demographics
NPI:1508182007
Name:VILLAGE OF DES MOINES
Entity Type:Organization
Organization Name:VILLAGE OF DES MOINES
Other - Org Name:DES MOINES AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRIESH
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT - I
Authorized Official - Phone:575-278-2101
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:NM
Mailing Address - Zip Code:88418-0127
Mailing Address - Country:US
Mailing Address - Phone:575-278-2127
Mailing Address - Fax:575-278-2126
Practice Address - Street 1:77 NORTH OLIVE ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:NM
Practice Address - Zip Code:88418
Practice Address - Country:US
Practice Address - Phone:575-278-3911
Practice Address - Fax:575-278-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20699OtherEMS/AMBULANCE STATE CERTIFICATION NUMBER