Healthcare Provider Details

I. General information

NPI: 1770170425
Provider Name (Legal Business Name): BLAKESBURG COMMUNITY FIRE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 02/03/2023
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 MONROE WAPELLO RD
BLAKESBURG IA
52536-8000
US

IV. Provider business mailing address

5621 MONROE WAPELLO RD
BLAKESBURG IA
52536-8000
US

V. Phone/Fax

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

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 Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS WOTEN
Title or Position: ASST. SERVICE DIRECTOR/CAPTAIN
Credential: EMT
Phone: 641-680-2888