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General NPI Number Information
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NPI Number | 1588614747
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Entity Type | Organization
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Legal Business Name | LEWIS TOWNSHIP TRUSTEES
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 19770 CYPRESS AVE
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-5499
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Country | US
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Telephone | 712-323-1093
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Fax | 712-323-9912
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Provider Business Mailing Address
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Address Line | PO BOX 965
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51502-0965
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Country | US
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Telephone | 712-323-1093
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Fax | 712-323-9912
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Authorized Official
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Title or Position | TRUSTEE
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Name | JACK OCONNELL
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Credential |
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Telephone | 712-323-1093
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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 | 2781300
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License Number State | IA
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