MEDICARE: CITY OF EDGEWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2281200	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07277	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518952670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF EDGEWOOD

Provider Business Mailing Address
First Line	:	39245 LITTLEPORT RD
Second Line	:
City	:	EDGEWOOD
State	:	IA
Zip	:	52042-8210
Country	:	US
Telephone Number	:	563-928-7399
Fax Number	:

Provider Business Practice Location Address
First Line	:	39245 LITTLEPORT RD
Second Line	:
City	:	EDGEWOOD
State	:	IA
Zip	:	52042-8210
Country	:	US
Telephone Number	:	563-928-7399
Fax Number	:

Authorized Official
Title or Position	:	AMBULANCE BILLING DIRECTOR
Name	:	MR. DUANE C. MILLARD
Credential	:	PARAMEDIC SPECIALIST
Telephone Number	:	563-928-7399

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	06/19/2008

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Directions to “CITY OF EDGEWOOD ” Practice Location

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