Healthcare Provider Details

I. General information

NPI: 1023238615
Provider Name (Legal Business Name): CITY OF BONDURANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 2ND ST NE
BONDURANT IA
50035-1021
US

IV. Provider business mailing address

200 2ND ST NE
BONDURANT IA
50035-1021
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-4902
  • Fax: 515-967-4902
Mailing address:
  • Phone: 515-967-4902
  • Fax: 515-967-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number2771800
License Number StateIA

VIII. Authorized Official

Name: MR. CHRISTOPHER JAYE BOGAARDS
Title or Position: EMS DIRECTOR
Credential:
Phone: 515-210-3349