Healthcare Provider Details

I. General information

NPI: 1275535353
Provider Name (Legal Business Name): CITY OF DYSART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MAIN STREET
DYSART IA
52224-0212
US

IV. Provider business mailing address

PO BOX 212
DYSART IA
52224-0212
US

V. Phone/Fax

Practice location:
  • Phone: 319-476-4911
  • Fax: 319-476-4910
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2860100
License Number StateIA

VIII. Authorized Official

Name: MR. STEVEN A WEEKLEY
Title or Position: EMS DIRECTOR
Credential:
Phone: 319-476-4911