MEDICARE: CITY OF POLK CITY

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	341600000X	Ambulance
2	341600000X	Ambulance	2771000	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073673463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF POLK CITY

Provider Business Mailing Address
First Line	:	PO BOX 426
Second Line	:	112 3RD ST
City	:	POLK CITY
State	:	IA
Zip	:	50226-0034
Country	:	US
Telephone Number	:	515-984-6233
Fax Number	:	515-984-6792

Provider Business Practice Location Address
First Line	:	309 W. VAN DORN
Second Line	:
City	:	POLK CITY
State	:	IA
Zip	:	50226-0034
Country	:	US
Telephone Number	:	515-984-6304
Fax Number	:	515-984-6792

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	DAN A. GUBBINS
Credential	:
Telephone Number	:	515-984-6304

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/29/2013

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Directions to “CITY OF POLK CITY ” Practice Location

Language	Start Address	Practice Location

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