Healthcare Provider Details

I. General information

NPI: 1063441194
Provider Name (Legal Business Name): BLAKESBURG FIRE & RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 MONROE WAPELLO RD.
BLAKESBURG IA
52536
US

IV. Provider business mailing address

5621 MONROE WAPELLO RD.
BLAKESBURG IA
52536
US

V. Phone/Fax

Practice location:
  • Phone: 641-680-2888
  • Fax: 877-882-9922
Mailing address:
  • Phone: 641-680-2888
  • Fax: 877-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2900900
License Number StateIA

VIII. Authorized Official

Name: CURTIS E WOTEN
Title or Position: ASST. SERVICE DIRECTOR
Credential: EMT
Phone: 640-680-2888