Provider Demographics
NPI:1528095056
Name:FARRAGUT FIRE & RESCUE ASSOCIATION
Entity type:Organization
Organization Name:FARRAGUT FIRE & RESCUE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-385-8319
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:IA
Mailing Address - Zip Code:51639-0060
Mailing Address - Country:US
Mailing Address - Phone:712-385-8661
Mailing Address - Fax:712-385-8426
Practice Address - Street 1:503 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:IA
Practice Address - Zip Code:51639-2014
Practice Address - Country:US
Practice Address - Phone:712-385-8661
Practice Address - Fax:712-385-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23607003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0233007Medicaid
IA26238OtherBCBS OF IA
IA0233007Medicaid