Provider Demographics
NPI:1023238615
Name:CITY OF BONDURANT
Entity type:Organization
Organization Name:CITY OF BONDURANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAYE
Authorized Official - Last Name:BOGAARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-210-3349
Mailing Address - Street 1:200 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1021
Mailing Address - Country:US
Mailing Address - Phone:515-967-4902
Mailing Address - Fax:515-967-4902
Practice Address - Street 1:200 2ND ST NE
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1021
Practice Address - Country:US
Practice Address - Phone:515-967-4902
Practice Address - Fax:515-967-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2771800261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0189092Medicaid
IA0189092Medicaid