Healthcare Provider Details

I. General information

NPI: 1760540173
Provider Name (Legal Business Name): CITY OF HULL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MAPLE STREET
HULL IA
51239
US

IV. Provider business mailing address

1133 MAPLE ST. BOX 816
HULL IA
51239-0186
US

V. Phone/Fax

Practice location:
  • Phone: 712-439-1521
  • Fax: 712-439-2512
Mailing address:
  • Phone: 712-439-1521
  • Fax: 712-439-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number2840300
License Number StateIA

VIII. Authorized Official

Name: MR. LES VAN ROEKEL
Title or Position: CITY ADMINISTRATOR
Credential:
Phone: 712-439-1521