Provider Demographics
NPI:1649213752
Name:CITY OF BLAIRSTOWN
Entity Type:Organization
Organization Name:CITY OF BLAIRSTOWN
Other - Org Name:BLAIRSTOWN FIRE DEPT OR BLAIRSTOWN AMBULANCE /EMS OR BLAIRSTOWN RESCUE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:319-454-0078
Mailing Address - Street 1:309 LOCUST ST NW
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:52209
Mailing Address - Country:US
Mailing Address - Phone:319-454-0078
Mailing Address - Fax:319-454-6709
Practice Address - Street 1:205 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:IA
Practice Address - Zip Code:52209
Practice Address - Country:US
Practice Address - Phone:319-454-0078
Practice Address - Fax:319-454-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20609003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC 16565OtherUNITED AMER INS CO
IA001417OtherPRINCIPAL LIFE INS CO
NVJ09900019506OtherSIERRA
GA590006388OtherPALMETTO GBA-RR MEDICARE
IA0165654Medicaid
IA41094OtherWELLMARK BC/BS
TX0004654218OtherAETNA PIN#
NVJ09900019506OtherSIERRA
GA590006388OtherPALMETTO GBA-RR MEDICARE
IA0165654Medicaid
TX0004654218OtherAETNA PIN#