Provider Demographics
NPI:1063574945
Name:FARNHAMVILLE EMS
Entity type:Organization
Organization Name:FARNHAMVILLE EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-332-5335
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:FARNHAMVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50538-0245
Mailing Address - Country:US
Mailing Address - Phone:866-332-5335
Mailing Address - Fax:866-887-2003
Practice Address - Street 1:350 HARDIN ST
Practice Address - Street 2:
Practice Address - City:FARNHAMVILLE
Practice Address - State:IA
Practice Address - Zip Code:50538
Practice Address - Country:US
Practice Address - Phone:866-332-5335
Practice Address - Fax:866-887-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21308003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0456673Medicaid
IA0456673Medicaid