Provider Demographics
NPI:1790858645
Name:WAVERLY HEALTH CENTER - AMBULANCE
Entity Type:Organization
Organization Name:WAVERLY HEALTH CENTER - AMBULANCE
Other - Org Name:WAVERLY MUNICIPAL HOSPITAL - AMBULANCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRACHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-4120
Mailing Address - Street 1:312 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2929
Mailing Address - Country:US
Mailing Address - Phone:319-352-4120
Mailing Address - Fax:319-352-8035
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-352-4120
Practice Address - Fax:319-352-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0044172Medicaid