Provider Demographics
NPI:1760554083
Name:TOWN OF FARMINGTON
Entity Type:Organization
Organization Name:TOWN OF FARMINGTON
Other - Org Name:FARMINGTON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PS
Authorized Official - Phone:319-878-3367
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52626-0154
Mailing Address - Country:US
Mailing Address - Phone:319-878-3367
Mailing Address - Fax:
Practice Address - Street 1:210 SOUTH 4TH ST.
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IA
Practice Address - Zip Code:52626-0154
Practice Address - Country:US
Practice Address - Phone:319-878-3367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2890900146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA590014234OtherRAILROAD MEDICARE
IA53584OtherBLUE CROSS
IA0143842Medicaid
IA0143842Medicaid