MEDICARE: CITY OF EARLVILLE

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	28658	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	:	1871655712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF EARLVILLE

Provider Business Mailing Address
First Line	:	19 NORTHERN AVE
Second Line	:
City	:	EARLVILLE
State	:	IA
Zip	:	52041-2547
Country	:	US
Telephone Number	:	563-923-3365
Fax Number	:	563-923-3115

Provider Business Practice Location Address
First Line	:	134 NORTHERN AVE
Second Line	:
City	:	EARLVILLE
State	:	IA
Zip	:	52041-0000
Country	:	US
Telephone Number	:	563-923-3365
Fax Number	:	563-923-3115

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAVE STAINER
Credential	:
Telephone Number	:	563-608-1145

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	04/30/2012

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Directions to “CITY OF EARLVILLE ” Practice Location

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