Provider Demographics
NPI:1932482973
Name:CITY OF FORT DODGE
Entity Type:Organization
Organization Name:CITY OF FORT DODGE
Other - Org Name:FORT DOGE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LUERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-576-1031
Mailing Address - Street 1:819 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4739
Mailing Address - Country:US
Mailing Address - Phone:515-573-7156
Mailing Address - Fax:515-573-2084
Practice Address - Street 1:1515 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4247
Practice Address - Country:US
Practice Address - Phone:515-576-1031
Practice Address - Fax:515-955-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12345673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1932482973OtherWELLMARK, BCBS OF IOWA
IA1932482973Medicaid
IA1932482973Medicaid