Healthcare Provider Details

I. General information

NPI: 1477185858
Provider Name (Legal Business Name): LEGRAND TOWNSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MAIN ST
LE GRAND IA
50142-7784
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 641-691-6911
  • 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: COURTNEY A STEPHENS
Title or Position: DIRECTOR
Credential:
Phone: 641-691-6911