Provider Demographics
NPI:1982678215
Name:TOWN OF COLESBURG
Entity Type:Organization
Organization Name:TOWN OF COLESBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-856-3185
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:COLESBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52035-0096
Mailing Address - Country:US
Mailing Address - Phone:563-856-3185
Mailing Address - Fax:563-856-2096
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLESBURG
Practice Address - State:IA
Practice Address - Zip Code:52035
Practice Address - Country:US
Practice Address - Phone:563-856-3185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0289801Medicaid
IA09290OtherBLUE CROSS BLUE SHIELD
IA0289801Medicaid
IA=========-01OtherJOHN DEERE HEALTH CARE