Provider Demographics
NPI:1619947199
Name:CITY OF INDIANOLA
Entity Type:Organization
Organization Name:CITY OF INDIANOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-961-9405
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:110 N FIRST
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-0299
Mailing Address - Country:US
Mailing Address - Phone:515-961-9405
Mailing Address - Fax:515-962-0108
Practice Address - Street 1:110 N FIRST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125
Practice Address - Country:US
Practice Address - Phone:515-961-9405
Practice Address - Fax:515-962-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29107341600000X
IA29107003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0235945Medicaid
IA23594Medicare PIN
IA23594Medicare UPIN
IA1619947199Medicare UPIN