Provider Demographics
NPI:1972501286
Name:CITY OF URBANDALE
Entity Type:Organization
Organization Name:CITY OF URBANDALE
Other - Org Name:URBANDALE FIRE/EMS DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF-DEPT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-331-6741
Mailing Address - Street 1:3927 121ST ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2300
Mailing Address - Country:US
Mailing Address - Phone:515-278-3970
Mailing Address - Fax:515-278-3972
Practice Address - Street 1:3927 121ST ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2300
Practice Address - Country:US
Practice Address - Phone:515-278-3970
Practice Address - Fax:515-278-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2771200146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265389Medicaid
49607OtherWELLMARK
49607OtherWELLMARK
49607OtherWELLMARK