MEDICARE: CITY OF FORT MADISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1043848237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF FORT MADISON

Provider Business Mailing Address
First Line	:	811 AVENUE E
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-2841
Country	:	US
Telephone Number	:	319-372-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 AVENUE L
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-4031
Country	:	US
Telephone Number	:	319-372-6472
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	JOEY HERREN
Credential	:
Telephone Number	:	319-372-7700

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	04/01/2020

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Directions to “CITY OF FORT MADISON ” Practice Location

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