Healthcare Provider Details

I. General information

NPI: 1528019049
Provider Name (Legal Business Name): CITY OF PACIFIC JUNCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 3RD ST
PACIFIC JUNCTION IA
51561-0337
US

IV. Provider business mailing address

PO BOX 337
PACIFIC JUNCTION IA
51561-0337
US

V. Phone/Fax

Practice location:
  • Phone: 515-887-3553
  • Fax: 515-887-2000
Mailing address:
  • Phone: 712-622-8177
  • Fax: 712-622-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2650400
License Number StateIA

VIII. Authorized Official

Name: LISA MAYO
Title or Position: DIRECTOR
Credential:
Phone: 712-622-8177