Healthcare Provider Details

I. General information

NPI: 1699704734
Provider Name (Legal Business Name): CITY OF ELLSWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 DEWITT ST
ELLSWORTH IA
50075-5006
US

IV. Provider business mailing address

PO BOX 310
ELLSWORTH IA
50075-0310
US

V. Phone/Fax

Practice location:
  • Phone: 877-882-9911
  • Fax: 877-882-9922
Mailing address:
  • Phone: 605-882-9911
  • Fax: 605-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2406200
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2406200
License Number StateIA

VIII. Authorized Official

Name: MRS. MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 877-882-9911