Provider Demographics
NPI:1316976244
Name:CITY OF LAKOTA
Entity type:Organization
Organization Name:CITY OF LAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:204 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:IA
Mailing Address - Zip Code:50597-7713
Mailing Address - Country:US
Mailing Address - Phone:515-887-3553
Mailing Address - Fax:515-887-2000
Practice Address - Street 1:205 BREWER ST
Practice Address - Street 2:
Practice Address - City:LAKOTA
Practice Address - State:IA
Practice Address - Zip Code:50451
Practice Address - Country:US
Practice Address - Phone:515-887-3553
Practice Address - Fax:515-887-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25510003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0079038Medicaid
IA0079038Medicaid