Provider Demographics
NPI:1669529384
Name:CITY OF DIKE
Entity type:Organization
Organization Name:CITY OF DIKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FREESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-989-2291
Mailing Address - Street 1:540 MAIN ST
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:DIKE
Mailing Address - State:IA
Mailing Address - Zip Code:50624-7724
Mailing Address - Country:US
Mailing Address - Phone:319-989-2291
Mailing Address - Fax:319-989-2694
Practice Address - Street 1:138 FRONT ST
Practice Address - Street 2:
Practice Address - City:DIKE
Practice Address - State:IA
Practice Address - Zip Code:50624
Practice Address - Country:US
Practice Address - Phone:319-989-2291
Practice Address - Fax:319-989-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23801003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0019000Medicaid
IA0019000Medicaid