Healthcare Provider Details

I. General information

NPI: 1255320420
Provider Name (Legal Business Name): CITY OF TRAER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 2ND ST
TRAER IA
50675-1230
US

IV. Provider business mailing address

649 2ND ST
TRAER IA
50675-1230
US

V. Phone/Fax

Practice location:
  • Phone: 319-478-2084
  • Fax: 319-478-2084
Mailing address:
  • Phone: 319-478-2084
  • Fax: 319-478-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2860700
License Number StateIA

VIII. Authorized Official

Name: STEVEN FULLER
Title or Position: CAPTAIN
Credential: EMT
Phone: 319-478-2084