Healthcare Provider Details

I. General information

NPI: 1073566444
Provider Name (Legal Business Name): BUFFALO VOLUNTEER AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W MAYNE ST
BLUE GRASS IA
52726-9706
US

IV. Provider business mailing address

PO BOX 307
BLUE GRASS IA
52726-0307
US

V. Phone/Fax

Practice location:
  • Phone: 563-381-1112
  • Fax: 563-381-5077
Mailing address:
  • Phone: 563-381-1112
  • Fax: 563-381-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: PHIL JONES
Title or Position: PRESIDENT
Credential:
Phone: 563-381-1112