Healthcare Provider Details

I. General information

NPI: 1417142480
Provider Name (Legal Business Name): REGION XII COUNCIL OF GOVERNMENTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 E ANTHONY ST
CARROLL IA
51401-3842
US

IV. Provider business mailing address

1009 E ANTHONY ST P.O. BOX 768
CARROLL IA
51401-3842
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-9914
  • Fax: 712-792-1751
Mailing address:
  • Phone: 712-792-9914
  • Fax: 712-792-1751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. THOMAS PATRICK FELDMAN
Title or Position: TRANSIT MANAGER
Credential:
Phone: 712-792-9914