Provider Demographics
NPI:1861470874
Name:PELLA COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:PELLA COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-628-1780
Mailing Address - Street 1:604 MAIN ST
Mailing Address - Street 2:BOX 911
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-0385
Mailing Address - Country:US
Mailing Address - Phone:641-628-1780
Mailing Address - Fax:641-628-1478
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:BOX 911
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1718
Practice Address - Country:US
Practice Address - Phone:641-628-1780
Practice Address - Fax:641-628-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26309003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190561Medicaid
IA19056Medicare PIN