=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831579630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF IRWIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2015
-----------------------------------------------------
Last Update Date | 06/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 FRONT ST
-----------------------------------------------------
City | IRWIN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51446-7718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-579-1980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 641880
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68164-7880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-572-4019
-----------------------------------------------------
Fax | 402-991-0719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESCUE CHIEF
-----------------------------------------------------
Name | TIMOTHY D PLUMB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-579-1980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 2830400
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------