Provider Demographics
NPI:1942214218
Name:CITY OF JOHNSTON
Entity Type:Organization
Organization Name:CITY OF JOHNSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KROHSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-276-5182
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:6015 NW 62ND AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-0410
Practice Address - Country:US
Practice Address - Phone:515-276-5182
Practice Address - Fax:515-334-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27708003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09411OtherWELLMARK BCBS
IA0487959Medicaid
IA09411OtherWELLMARK BLUE CHOICE
IA09411OtherWELLMARK BLUE ACCESS
IA09411OtherWELLMARK BLUE ADVANTAGE
IA09411OtherWELLMARK BLUE ADVANTAGE
IA09411OtherWELLMARK BLUE ADVANTAGE
IA09411OtherWELLMARK BLUE CHOICE