Provider Demographics
NPI:1003861154
Name:MARMAC EMERGENCY SQUAD INC
Entity type:Organization
Organization Name:MARMAC EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-873-3896
Mailing Address - Street 1:P.O. BOX 386
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:IA
Mailing Address - Zip Code:52157-0386
Mailing Address - Country:US
Mailing Address - Phone:563-873-3896
Mailing Address - Fax:563-873-3896
Practice Address - Street 1:205 4TH STREET
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:IA
Practice Address - Zip Code:52157-0386
Practice Address - Country:US
Practice Address - Phone:563-873-3896
Practice Address - Fax:563-873-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
IA22203003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010517OtherADVOCARE MCHMO
0416164OtherHERITAGE MA
426004957011OtherVALLEY HEALTH PLAN
0416164OtherIA HEALTH SOLUTIONS
IA37185OtherBCBS IA
P00123785OtherMEDICARE RAILROAD
426004957011OtherBCBS
IA0100OtherJOHN DEERE
IA0416164Medicaid
000010517OtherADVOCARE MCHMO
I10517Medicare UPIN