Provider Demographics
NPI:1588705206
Name:CITY OF WEST LIBERTY
Entity type:Organization
Organization Name:CITY OF WEST LIBERTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTP
Authorized Official - Phone:563-880-2382
Mailing Address - Street 1:409 N CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1344
Mailing Address - Country:US
Mailing Address - Phone:319-627-2418
Mailing Address - Fax:319-627-4847
Practice Address - Street 1:109 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1500
Practice Address - Country:US
Practice Address - Phone:319-627-2303
Practice Address - Fax:319-627-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1588705206Medicaid
IA1588705206Medicare PIN