Healthcare Provider Details

I. General information

NPI: 1366428716
Provider Name (Legal Business Name): CITY OF COUNCIL BLUFFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 4TH ST EMERGENCY MEDICAL SERVICE
COUNCIL BLUFFS IA
51503-6529
US

IV. Provider business mailing address

209 PEARL ST FINANCE DEPARTMENT
COUNCIL BLUFFS IA
51503
US

V. Phone/Fax

Practice location:
  • Phone: 712-328-4646
  • Fax: 712-328-4984
Mailing address:
  • Phone: 712-328-4605
  • Fax: 712-328-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2780200
License Number StateIA

VIII. Authorized Official

Name: MR. RICK BENSON
Title or Position: EMS OFFICER
Credential:
Phone: 712-328-4622