Provider Demographics
NPI:1760540173
Name:CITY OF HULL
Entity Type:Organization
Organization Name:CITY OF HULL
Other - Org Name:HULL EMERGENCY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ROEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-439-1521
Mailing Address - Street 1:1133 MAPLE ST. BOX 816
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:IA
Mailing Address - Zip Code:51239-0186
Mailing Address - Country:US
Mailing Address - Phone:712-439-1521
Mailing Address - Fax:712-439-2512
Practice Address - Street 1:1133 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:IA
Practice Address - Zip Code:51239
Practice Address - Country:US
Practice Address - Phone:712-439-1521
Practice Address - Fax:712-439-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2840300146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0086595Medicaid
IA08659OtherBLUE CROSS
IA08659OtherBLUE CROSS