Provider Demographics
NPI:1215988431
Name:CITY OF CLARION
Entity type:Organization
Organization Name:CITY OF CLARION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF POLICE/AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENNIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-532-3831
Mailing Address - Street 1:120 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1471
Mailing Address - Country:US
Mailing Address - Phone:515-532-3831
Mailing Address - Fax:515-532-6326
Practice Address - Street 1:120 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1471
Practice Address - Country:US
Practice Address - Phone:515-532-3831
Practice Address - Fax:515-532-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2990200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05575OtherBLUE CROSS & BLUE SHIELD
IA055756Medicaid
IA05575Medicare ID - Type Unspecified