Provider Demographics
NPI:1134199318
Name:CITY OF WAPELLO
Entity type:Organization
Organization Name:CITY OF WAPELLO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:REMT-P/PS/CCP
Authorized Official - Phone:319-527-5453
Mailing Address - Street 1:400 HIGHWAY 61 S
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1359
Mailing Address - Country:US
Mailing Address - Phone:319-527-5453
Mailing Address - Fax:319-527-5453
Practice Address - Street 1:400 HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1359
Practice Address - Country:US
Practice Address - Phone:319-527-5453
Practice Address - Fax:319-527-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25803003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0272922Medicaid
IA27292Medicare ID - Type UnspecifiedMEDICARE PROVIDER #