Healthcare Provider Details

I. General information

NPI: 1134199318
Provider Name (Legal Business Name): CITY OF WAPELLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHWAY 61 S
WAPELLO IA
52653-1359
US

IV. Provider business mailing address

400 HIGHWAY 61 S
WAPELLO IA
52653-1359
US

V. Phone/Fax

Practice location:
  • Phone: 319-527-5453
  • Fax: 319-527-5453
Mailing address:
  • Phone: 319-527-5453
  • Fax: 319-527-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2580300
License Number StateIA

VIII. Authorized Official

Name: JASON C GRIFFIN
Title or Position: SERVICE DIRECTOR
Credential: REMT-P/PS/CCP
Phone: 319-527-5453