Healthcare Provider Details

I. General information

NPI: 1174532246
Provider Name (Legal Business Name): COMMUNITY AMBULANCE SERVICE OF PRESTON IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 N SIMPSON ST
PRESTON IA
52069-7730
US

IV. Provider business mailing address

42 N SIMPSON ST
PRESTON IA
52069-7730
US

V. Phone/Fax

Practice location:
  • Phone: 563-687-3301
  • Fax: 563-689-3303
Mailing address:
  • Phone: 563-689-3301
  • Fax: 563-689-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2490600
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0127696
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. KENNETH J ANDERSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 563-689-3301