Healthcare Provider Details

I. General information

NPI: 1578257168
Provider Name (Legal Business Name): SOUTHERN IOWA TROLLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MONTGOMERY ST
CRESTON IA
50801-2551
US

IV. Provider business mailing address

215 E MONTGOMERY ST
CRESTON IA
50801-2551
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-6571
  • Fax: 641-782-4096
Mailing address:
  • Phone: 641-782-6571
  • Fax: 641-782-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: LEESA ANN LESTER
Title or Position: TRANSIT DIRECTOR
Credential:
Phone: 641-782-6571