Healthcare Provider Details

I. General information

NPI: 1114914819
Provider Name (Legal Business Name): COUNTY OF MADISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N JOHN WAYNE DR
WINTERSET IA
50273-1233
US

IV. Provider business mailing address

1008 N JOHN WAYNE DR
WINTERSET IA
50273-1233
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-2253
  • Fax: 515-462-2255
Mailing address:
  • Phone: 515-462-2253
  • Fax: 515-462-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TADD DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 515-462-2253