Provider Demographics
NPI:1801861950
Name:MEDIC EMS
Entity Type:Organization
Organization Name:MEDIC EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERMEER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:563-210-0801
Mailing Address - Street 1:1204 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2436
Mailing Address - Country:US
Mailing Address - Phone:563-323-6806
Mailing Address - Fax:563-323-1705
Practice Address - Street 1:1204 E HIGH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2436
Practice Address - Country:US
Practice Address - Phone:563-323-6806
Practice Address - Fax:563-323-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28210003416L0300X
IL0126703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0208256Medicaid
IA02431OtherWELLMARK BC/BS IA
IL=========001Medicaid
IL=========001Medicaid