Provider Demographics
NPI:1366424418
Name:MIDLAND AMBULANCE SERVICE
Entity type:Organization
Organization Name:MIDLAND AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRINK
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC SPECIALIST
Authorized Official - Phone:319-462-5817
Mailing Address - Street 1:104 BROADWAY PLACE
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205
Mailing Address - Country:US
Mailing Address - Phone:319-462-5817
Mailing Address - Fax:319-462-4689
Practice Address - Street 1:108 SOUTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:IA
Practice Address - Zip Code:52362
Practice Address - Country:US
Practice Address - Phone:563-488-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25304003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0072082Medicaid
IA07208Medicare ID - Type UnspecifiedPROVIDER NUMBER