Provider Demographics
NPI:1932269669
Name:WATERVILLE FIRE DEPT VOLUNTEER RESCUE SQUAD
Entity Type:Organization
Organization Name:WATERVILLE FIRE DEPT VOLUNTEER RESCUE SQUAD
Other - Org Name:WATERVILLE AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:563-568-3411
Mailing Address - Street 1:40 FIRST STREET SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2022
Mailing Address - Country:US
Mailing Address - Phone:563-568-3411
Mailing Address - Fax:563-568-6139
Practice Address - Street 1:84 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52170-7519
Practice Address - Country:US
Practice Address - Phone:563-535-7261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLAMAKEE EMS ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20308003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20816OtherBLUE CROSS & BLUE SHIELD
IAIB1358Medicare PIN