Provider Demographics
NPI:1528019049
Name:CITY OF PACIFIC JUNCTION
Entity Type:Organization
Organization Name:CITY OF PACIFIC JUNCTION
Other - Org Name:PACIFIC JUNCTION FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-622-8177
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:PACIFIC JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:51561-0337
Mailing Address - Country:US
Mailing Address - Phone:712-622-8177
Mailing Address - Fax:712-622-8400
Practice Address - Street 1:205 3RD ST
Practice Address - Street 2:
Practice Address - City:PACIFIC JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:51561-0337
Practice Address - Country:US
Practice Address - Phone:515-887-3553
Practice Address - Fax:515-887-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26504003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200369430AMedicaid
IA01395OtherBLUE CROSS BLUE SHIELD
P00018356OtherRAILROAD MEDICARE
NE10025347200Medicaid
8100234OtherUNITED HEALTHCARE
SD9011250Medicaid
IA0013953Medicaid
8100234OtherUNITED HEALTHCARE