MEDICARE: CITY OF ROCKWELL 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	3416L0300X	Land Ambulance	2130700	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14138	OTHER	IA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447327630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ROCKWELL CITY

Provider Business Mailing Address
First Line	:	335 MAIN ST
Second Line	:
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579-1536
Country	:	US
Telephone Number	:	712-297-7041
Fax Number	:	712-297-5626

Provider Business Practice Location Address
First Line	:	335 MAIN ST
Second Line	:
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579-1536
Country	:	US
Telephone Number	:	712-297-7041
Fax Number	:	712-297-5626

Authorized Official
Title or Position	:	AMBULANCE DIRECTOR
Name	:	TRAE THOMAS
Credential	:
Telephone Number	:	712-297-7199

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/16/2007

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Directions to “CITY OF ROCKWELL CITY ” Practice Location

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