Provider Demographics
NPI:1558313668
Name:CITY OF TABOR
Entity Type:Organization
Organization Name:CITY OF TABOR
Other - Org Name:TABOR AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-629-2295
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:IA
Mailing Address - Zip Code:51653-0309
Mailing Address - Country:US
Mailing Address - Phone:712-629-2295
Mailing Address - Fax:712-629-1019
Practice Address - Street 1:626 MAIN ST
Practice Address - Street 2:
Practice Address - City:TABOR
Practice Address - State:IA
Practice Address - Zip Code:51653-6018
Practice Address - Country:US
Practice Address - Phone:712-629-2295
Practice Address - Fax:712-629-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23604003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0069476Medicaid
IA06947OtherBCBS OF IOWA
8181992OtherUNITED HEALTHCARE
8181992OtherUNITED HEALTHCARE
IA06947OtherBCBS OF IOWA