Provider Demographics
NPI:1124172028
Name:CITY OF ESSEX
Entity type:Organization
Organization Name:CITY OF ESSEX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:CMC
Authorized Official - Phone:712-379-3444
Mailing Address - Street 1:412 IOWA AVE
Mailing Address - Street 2:PO BOX 428
Mailing Address - City:ESSEX
Mailing Address - State:IA
Mailing Address - Zip Code:51638
Mailing Address - Country:US
Mailing Address - Phone:712-379-3444
Mailing Address - Fax:712-379-3415
Practice Address - Street 1:412 IOWA AVE.
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:IA
Practice Address - Zip Code:51638
Practice Address - Country:US
Practice Address - Phone:712-379-3444
Practice Address - Fax:712-379-3415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF ESSEX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2731000341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120691Medicaid
IA18392OtherWELLMARK BCBS OF IA
IA0120691Medicaid
IA18392Medicare PIN