Provider Demographics
NPI:1871655712
Name:CITY OF EARLVILLE
Entity Type:Organization
Organization Name:CITY OF EARLVILLE
Other - Org Name:EARLVILLE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-608-1145
Mailing Address - Street 1:19 NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52041-2547
Mailing Address - Country:US
Mailing Address - Phone:563-923-3365
Mailing Address - Fax:563-923-3115
Practice Address - Street 1:134 NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:EARLVILLE
Practice Address - State:IA
Practice Address - Zip Code:52041-0000
Practice Address - Country:US
Practice Address - Phone:563-923-3365
Practice Address - Fax:563-923-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA286583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0293845Medicaid
IA29384Medicare PIN