=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124172028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF ESSEX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 IOWA AVE.
-----------------------------------------------------
City | ESSEX
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-379-3444
-----------------------------------------------------
Fax | 712-379-3415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 IOWA AVE PO BOX 428
-----------------------------------------------------
City | ESSEX
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-379-3444
-----------------------------------------------------
Fax | 712-379-3415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CITY CLERK
-----------------------------------------------------
Name | MRS. LISA ANN ROYER
-----------------------------------------------------
Credential | CMC
-----------------------------------------------------
Telephone | 712-379-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 2731000
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------