Healthcare Provider Details

I. General information

NPI: 1710048020
Provider Name (Legal Business Name): CITY OF SHELL ROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S CHERRY STREET
SHELL ROCK IA
50670-0522
US

IV. Provider business mailing address

PO BOX 522
SHELL ROCK IA
50670-0522
US

V. Phone/Fax

Practice location:
  • Phone: 319-885-6555
  • Fax: 319-885-6556
Mailing address:
  • Phone: 319-885-6555
  • Fax: 319-885-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2120600
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0007625
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: RACHEL NIEMAN
Title or Position: DEPT CITY CLERK
Credential:
Phone: 319-885-6555