=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225184864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDWEST AMBULANCE SERVICE OF IOWA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 09/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1229 OHIO ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50314-3116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-244-0409
-----------------------------------------------------
Fax | 515-243-4932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2535 106TH ST
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50322-3766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-252-1721
-----------------------------------------------------
Fax | 515-252-1725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KIM EUGENE CHAPMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-252-1721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 2772000
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------