Provider Demographics
NPI:1427080662
Name:CITY OF GRANGER
Entity type:Organization
Organization Name:CITY OF GRANGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:515-999-2210
Mailing Address - Street 1:1906 MAIN STREET
Mailing Address - Street 2:P.O. BOX 391
Mailing Address - City:GRANGER
Mailing Address - State:IA
Mailing Address - Zip Code:50109
Mailing Address - Country:US
Mailing Address - Phone:515-999-2210
Mailing Address - Fax:515-999-2338
Practice Address - Street 1:1906 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IA
Practice Address - Zip Code:50109
Practice Address - Country:US
Practice Address - Phone:515-999-2210
Practice Address - Fax:515-999-2338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF GRANGER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22505003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0731661Medicaid
IA0731661Medicaid