Provider Demographics
NPI:1619033990
Name:CITY OF JESUP
Entity Type:Organization
Organization Name:CITY OF JESUP
Other - Org Name:JESUP AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-887-3553
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:IA
Mailing Address - Zip Code:50648-0592
Mailing Address - Country:US
Mailing Address - Phone:515-887-3553
Mailing Address - Fax:515-887-2000
Practice Address - Street 1:601 YOUNG ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:IA
Practice Address - Zip Code:50648-1176
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:2006-12-29
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0156851Medicaid
IA15685Medicare PIN