Provider Demographics
NPI:1710048020
Name:CITY OF SHELL ROCK
Entity Type:Organization
Organization Name:CITY OF SHELL ROCK
Other - Org Name:CITY OF SHELL ROCK AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPT CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-885-6555
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:SHELL ROCK
Mailing Address - State:IA
Mailing Address - Zip Code:50670-0522
Mailing Address - Country:US
Mailing Address - Phone:319-885-6555
Mailing Address - Fax:319-885-6556
Practice Address - Street 1:303 S CHERRY STREET
Practice Address - Street 2:
Practice Address - City:SHELL ROCK
Practice Address - State:IA
Practice Address - Zip Code:50670-0522
Practice Address - Country:US
Practice Address - Phone:319-885-6555
Practice Address - Fax:319-885-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21206003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0007625Medicaid
IA0007625Medicaid