Provider Demographics
NPI:1700814167
Name:MELCHER-DALLAS
Entity Type:Organization
Organization Name:MELCHER-DALLAS
Other - Org Name:MELCHER-DALLAS FIRE RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:VRBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-962-0108
Mailing Address - Street 1:200 CENTER ST
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:MELCHER
Mailing Address - State:IA
Mailing Address - Zip Code:50163
Mailing Address - Country:US
Mailing Address - Phone:515-962-0108
Mailing Address - Fax:515-962-0108
Practice Address - Street 1:200 CENTER ST
Practice Address - Street 2:
Practice Address - City:MELCHER
Practice Address - State:IA
Practice Address - Zip Code:50163
Practice Address - Country:US
Practice Address - Phone:515-962-0108
Practice Address - Fax:515-962-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2630400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55504Medicare ID - Type Unspecified