Healthcare Provider Details

I. General information

NPI: 1083770382
Provider Name (Legal Business Name): CITY OF STRATFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 HIGHWAY 175
STRATFORD IA
50249-7709
US

IV. Provider business mailing address

PO BOX 218
STRATFORD IA
50249-0218
US

V. Phone/Fax

Practice location:
  • Phone: 515-887-3553
  • Fax: 515-887-2000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number24003
License Number StateIA

VIII. Authorized Official

Name: ANGIE WEICHERT
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 515-887-3553