Provider Demographics
NPI:1396787529
Name:IDA GROVE AMBULANCE SERVICE
Entity type:Organization
Organization Name:IDA GROVE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:701 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1666
Mailing Address - Country:US
Mailing Address - Phone:877-882-9911
Mailing Address - Fax:877-882-9922
Practice Address - Street 1:702 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1613
Practice Address - Country:US
Practice Address - Phone:877-882-9911
Practice Address - Fax:877-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24703003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06338OtherBCBS
IA0063388Medicaid
IA06338Medicare PIN
IA0063388Medicaid