=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689898975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLE PLAINE AREA AMBULANCE SERVICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 11/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 1/2 13TH STREET
-----------------------------------------------------
City | BELLE PLAINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-444-3808
-----------------------------------------------------
Fax | 319-444-4459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1308 1/2 13TH STREET
-----------------------------------------------------
City | BELLE PLAINE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-444-3808
-----------------------------------------------------
Fax | 319-444-4459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. DANIEL JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-444-3808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 2060800
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------