=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275675290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF SHELBY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 09/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 CENTER ST BOX #6
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51570-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-544-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 186 419 EAST STREET
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-544-2404
-----------------------------------------------------
Fax | 712-544-2703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CITY CLERK
-----------------------------------------------------
Name | MRS. CHRISTIE L MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-544-2404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 2830800
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------