Provider Demographics
NPI:1588614747
Name:LEWIS TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:LEWIS TOWNSHIP TRUSTEES
Other - Org Name:LEWIS TOWNSHIP FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-323-1093
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-0965
Mailing Address - Country:US
Mailing Address - Phone:712-323-1093
Mailing Address - Fax:712-323-9912
Practice Address - Street 1:19770 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5499
Practice Address - Country:US
Practice Address - Phone:712-323-1093
Practice Address - Fax:712-323-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27813003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54401OtherBLUE CROSS BLUE SHIELD
IA0414599Medicaid
8100224OtherUNITED HEALTHCARE
NE10025287000Medicaid
590015633OtherRAILROAD MEDICARE
NE10025287000Medicaid
IA54401OtherBLUE CROSS BLUE SHIELD