Healthcare Provider Details

I. General information

NPI: 1376643403
Provider Name (Legal Business Name): CITY OF WELLSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N WASHINGTON ST
WELLSBURG IA
50680-7677
US

IV. Provider business mailing address

505 N WASHINGTON ST P.O. BOX L
WELLSBURG IA
50680-7677
US

V. Phone/Fax

Practice location:
  • Phone: 641-869-3342
  • Fax: 641-869-3342
Mailing address:
  • Phone: 641-869-3342
  • Fax: 641-869-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateIA

VIII. Authorized Official

Name: WENDY J LAGE
Title or Position: CITY CLERK
Credential:
Phone: 641-869-3342