Healthcare Provider Details

I. General information

NPI: 1720140635
Provider Name (Legal Business Name): CLAIRE FIRE & RESCUE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRONT STREET
CLARE IA
50524
US

IV. Provider business mailing address

PO BOX 10
CLARE IA
50524-0010
US

V. Phone/Fax

Practice location:
  • Phone: 866-332-5335
  • Fax: 866-887-2003
Mailing address:
  • Phone: 866-332-5335
  • Fax: 866-887-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2940500
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0297218
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: ANGIE WEICHERT
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 866-332-5335