Provider Demographics
NPI:1013054089
Name:BENTON-LINN AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:BENTON-LINN AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY,TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:319-851-4831
Mailing Address - Street 1:505 VINTON ST.
Mailing Address - Street 2:BOX 276
Mailing Address - City:PALO
Mailing Address - State:IA
Mailing Address - Zip Code:52324-0276
Mailing Address - Country:US
Mailing Address - Phone:319-851-4831
Mailing Address - Fax:319-851-4831
Practice Address - Street 1:505 VINTON ST
Practice Address - Street 2:BOX 276
Practice Address - City:PALO
Practice Address - State:IA
Practice Address - Zip Code:52324-0276
Practice Address - Country:US
Practice Address - Phone:319-851-4831
Practice Address - Fax:319-851-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0133124Medicaid
IA0133124Medicaid