Healthcare Provider Details

I. General information

NPI: 1538203922
Provider Name (Legal Business Name): TOWN OF COLUMBUS JCT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GAMBLE ST
COLUMBUS JUNCTION IA
52738
US

IV. Provider business mailing address

105 GAMBLE ST
COLUMBUS JUNCTION IA
52738
US

V. Phone/Fax

Practice location:
  • Phone: 319-728-7740
  • Fax: 319-728-7740
Mailing address:
  • Phone: 319-728-7740
  • Fax: 319-728-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number02580100
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0071738
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: JAMES W INGHAM
Title or Position: EMS DIRECTOR
Credential: NRP
Phone: 319-728-7740