Healthcare Provider Details

I. General information

NPI: 1801937040
Provider Name (Legal Business Name): CITY OF FAIRBANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GROVE ST
FAIRBANK IA
50629-8650
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 319-635-2981
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax: 888-506-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY J GORDON
Title or Position: FIRE CHIEF
Credential:
Phone: 563-380-9519