Provider Demographics
NPI:1467548636
Name:CITY OF MONTEZUMA
Entity type:Organization
Organization Name:CITY OF MONTEZUMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:MERYLL
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-623-5617
Mailing Address - Street 1:503 E MAIN ST
Mailing Address - Street 2:PO BOX 314
Mailing Address - City:MONTEZUMA
Mailing Address - State:IA
Mailing Address - Zip Code:50171-0314
Mailing Address - Country:US
Mailing Address - Phone:641-623-5617
Mailing Address - Fax:641-623-3726
Practice Address - Street 1:503 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:IA
Practice Address - Zip Code:50171-0314
Practice Address - Country:US
Practice Address - Phone:641-623-5617
Practice Address - Fax:641-623-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27903003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0045310Medicaid
IA0045310Medicaid