Provider Demographics
NPI:1184813990
Name:FONDA CITY OF
Entity type:Organization
Organization Name:FONDA CITY OF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-288-4466
Mailing Address - Street 1:104 W SECOND ST
Mailing Address - Street 2:
Mailing Address - City:FONDA
Mailing Address - State:IA
Mailing Address - Zip Code:50540-0367
Mailing Address - Country:US
Mailing Address - Phone:712-288-4466
Mailing Address - Fax:712-288-6633
Practice Address - Street 1:104 W SECOND ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:IA
Practice Address - Zip Code:50540-0367
Practice Address - Country:US
Practice Address - Phone:712-288-4466
Practice Address - Fax:712-288-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2760100341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
03693OtherWELLMARK
I8838Medicare PIN