Healthcare Provider Details

I. General information

NPI: 1194729855
Provider Name (Legal Business Name): SOUTHEAST IOWA AMBULANCE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4165 NAPLES AVE SW STE 5
IOWA CITY IA
52240-8624
US

IV. Provider business mailing address

4165 NAPLES AVE SW STE 5
IOWA CITY IA
52240-8624
US

V. Phone/Fax

Practice location:
  • Phone: 319-466-0735
  • Fax: 319-466-0740
Mailing address:
  • Phone: 319-466-0735
  • Fax: 319-466-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2520400
License Number StateIA

VIII. Authorized Official

Name: MR. RUSSELL JOHN BAILEY
Title or Position: DIRECTOR/CEO
Credential:
Phone: 319-466-0735