Provider Demographics
NPI:1104950963
Name:RICEVILLE AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:RICEVILLE AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-985-2452
Mailing Address - Street 1:915 WOODLAND AVE
Mailing Address - Street 2:P.O. BOX 39
Mailing Address - City:RICEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50466-7507
Mailing Address - Country:US
Mailing Address - Phone:641-985-2452
Mailing Address - Fax:641-985-2204
Practice Address - Street 1:915 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50466-7507
Practice Address - Country:US
Practice Address - Phone:641-985-2452
Practice Address - Fax:641-985-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2660300341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19004Medicare PIN