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General NPI Number Information
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NPI Number | 1215934849
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Entity Type | Organization
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Legal Business Name | MEDIVAC CORP
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 812 CYCLONE AVE
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City | HARLAN
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State | IA
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Zip | 51537-1300
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Country | US
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Telephone | 712-755-3800
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Fax | 712-755-7151
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Provider Business Mailing Address
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Address Line | 812 CYCLONE AVE P.O. BOX 348
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City | HARLAN
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State | IA
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Zip | 51537-1300
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Country | US
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Telephone | 712-755-3800
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Fax | 712-755-7151
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. DAVID MILLER
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Credential |
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Telephone | 712-755-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 5105
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 2830700
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License Number State | IA
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