Provider Demographics
NPI:1942367362
Name:CITY OF WEST LIBERTY
Entity Type:Organization
Organization Name:CITY OF WEST LIBERTY
Other - Org Name:WEST LIBERTY VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:319-627-2303
Mailing Address - Street 1:409 N CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1344
Mailing Address - Country:US
Mailing Address - Phone:319-627-2418
Mailing Address - Fax:
Practice Address - Street 1:109 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1500
Practice Address - Country:US
Practice Address - Phone:319-627-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2700700146L00000X, 146M00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty