Provider Demographics
NPI:1992829071
Name:CITY OF UTE
Entity Type:Organization
Organization Name:CITY OF UTE
Other - Org Name:UTE AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-887-3553
Mailing Address - Street 1:169 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UTE
Mailing Address - State:IA
Mailing Address - Zip Code:51060-7705
Mailing Address - Country:US
Mailing Address - Phone:712-885-2571
Mailing Address - Fax:
Practice Address - Street 1:158 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UTE
Practice Address - State:IA
Practice Address - Zip Code:51060-0000
Practice Address - Country:US
Practice Address - Phone:712-885-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA13673OtherWELLMARK BC BS NUMBER
IA0136739Medicaid
IA0136739Medicaid
IA13673OtherWELLMARK BC BS NUMBER