Provider Demographics
NPI:1720017684
Name:OTO COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:OTO COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:OTO
Mailing Address - State:IA
Mailing Address - Zip Code:51044-0025
Mailing Address - Country:US
Mailing Address - Phone:712-840-1447
Mailing Address - Fax:
Practice Address - Street 1:27 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OTO
Practice Address - State:IA
Practice Address - Zip Code:51044-7705
Practice Address - Country:US
Practice Address - Phone:712-840-1447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29721003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0210278Medicaid
IA0210278Medicaid