Provider Demographics
NPI:1366428716
Name:CITY OF COUNCIL BLUFFS
Entity type:Organization
Organization Name:CITY OF COUNCIL BLUFFS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-328-4622
Mailing Address - Street 1:209 PEARL ST
Mailing Address - Street 2:FINANCE DEPARTMENT
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503
Mailing Address - Country:US
Mailing Address - Phone:712-328-4605
Mailing Address - Fax:712-328-4997
Practice Address - Street 1:200 S 4TH ST
Practice Address - Street 2:EMERGENCY MEDICAL SERVICE
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-6529
Practice Address - Country:US
Practice Address - Phone:712-328-4646
Practice Address - Fax:712-328-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2780200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0045138Medicaid
IA0045138Medicaid
IA590012287Medicare PIN