Provider Demographics
NPI:1154342327
Name:CITY OF CLEAR LAKE CITY CLERK
Entity type:Organization
Organization Name:CITY OF CLEAR LAKE CITY CLERK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-357-5267
Mailing Address - Street 1:204 1ST AVE NW
Mailing Address - Street 2:PO BOX 480
Mailing Address - City:WEST BEND
Mailing Address - State:IA
Mailing Address - Zip Code:50597-0480
Mailing Address - Country:US
Mailing Address - Phone:641-357-2186
Mailing Address - Fax:641-357-7172
Practice Address - Street 1:511 1ST AVE N
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1801
Practice Address - Country:US
Practice Address - Phone:641-357-2186
Practice Address - Fax:641-357-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21704003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0492504Medicaid
IAI17128Medicare PIN