Healthcare Provider Details

I. General information

NPI: 1093889644
Provider Name (Legal Business Name): CITY OF EAGLE GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E BROADWAY ST
EAGLE GROVE IA
50533-1813
US

IV. Provider business mailing address

PO BOX 165
EAGLE GROVE IA
50533-0165
US

V. Phone/Fax

Practice location:
  • Phone: 515-448-4686
  • Fax: 515-448-3761
Mailing address:
  • Phone: 515-448-4686
  • Fax: 515-448-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2990300
License Number StateIA

VIII. Authorized Official

Name: MATT MADSON
Title or Position: EMS DIRECTOR
Credential:
Phone: 515-448-4686