Provider Demographics
NPI:1770170425
Name:BLAKESBURG COMMUNITY FIRE BOARD
Entity type:Organization
Organization Name:BLAKESBURG COMMUNITY FIRE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SERVICE DIRECTOR/CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:641-680-2888
Mailing Address - Street 1:5621 MONROE WAPELLO RD
Mailing Address - Street 2:
Mailing Address - City:BLAKESBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52536-8000
Mailing Address - Country:US
Mailing Address - Phone:641-680-2888
Mailing Address - Fax:
Practice Address - Street 1:5621 MONROE WAPELLO RD
Practice Address - Street 2:
Practice Address - City:BLAKESBURG
Practice Address - State:IA
Practice Address - Zip Code:52536-8000
Practice Address - Country:US
Practice Address - Phone:641-680-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0452458Medicaid
IA07161OtherBCBS