MEDICARE: CITY OF CARTER LAKE

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	2781000	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00174799	OTHER		RAILROAD MEDICARE NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37769	OTHER	IA	BLUE CROSS PROVIDER NO
2	09455	OTHER	NE	BLUE CROSS PROVIDER NO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902884885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CARTER LAKE

Provider Business Mailing Address
First Line	:	950 LOCUST ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1529
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Provider Business Practice Location Address
First Line	:	2911 N 9TH ST
Second Line	:
City	:	CARTER LAKE
State	:	IA
Zip	:	51510-1501
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Authorized Official
Title or Position	:	CITY CLERK
Name	:	DOREEN MOWERY
Credential	:
Telephone Number	:	402-572-4019

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/22/2020

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Directions to “CITY OF CARTER LAKE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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