Healthcare Provider Details

I. General information

NPI: 1376610576
Provider Name (Legal Business Name): CITY OF EVANSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 S EVANS RD
EVANSDALE IA
50707-1647
US

IV. Provider business mailing address

123 N EVANS RD
EVANSDALE IA
50707-1115
US

V. Phone/Fax

Practice location:
  • Phone: 319-233-6930
  • Fax: 319-274-8966
Mailing address:
  • Phone: 319-232-6683
  • Fax: 319-232-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2070400
License Number StateIA

VIII. Authorized Official

Name: KENT SMOCK
Title or Position: AMBULANCE DIRECTOR
Credential:
Phone: 319-233-6930