Healthcare Provider Details

I. General information

NPI: 1700814167
Provider Name (Legal Business Name): MELCHER-DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CENTER ST
MELCHER IA
50163
US

IV. Provider business mailing address

200 CENTER ST PO BOX 548
MELCHER IA
50163
US

V. Phone/Fax

Practice location:
  • Phone: 515-962-0108
  • Fax: 515-962-0108
Mailing address:
  • Phone: 515-962-0108
  • Fax: 515-962-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2630400
License Number StateIA

VIII. Authorized Official

Name: VANCE P VRBAN
Title or Position: TREASURER
Credential:
Phone: 515-962-0108