Healthcare Provider Details

I. General information

NPI: 1275581837
Provider Name (Legal Business Name): OUTWARD MOBILITY MEDICAL TRANSPORTATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W IOWA AVE
DUNLAP IA
51529-1559
US

IV. Provider business mailing address

31 W IOWA AVE
DUNLAP IA
51529-1559
US

V. Phone/Fax

Practice location:
  • Phone: 888-813-1639
  • Fax: 712-643-5661
Mailing address:
  • Phone: 888-813-1639
  • Fax: 712-643-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2430800
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0159202
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHEAL DAVID BONSALL
Title or Position: PRESIDENT/OWNER
Credential: RRT-NPS, EMT-B
Phone: 888-813-1639