Provider Demographics
NPI:1255526935
Name:TOWN OF MASSENA
Entity type:Organization
Organization Name:TOWN OF MASSENA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. AMBULANCE CO- CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-250-1332
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:IA
Practice Address - Zip Code:50853-1032
Practice Address - Country:US
Practice Address - Phone:712-779-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2150400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1100Medicare UPIN