MEDICARE: HARPERS FERRY RESCUE UNIT FUND

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	2030100	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06248	OTHER	IA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1972570265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARPERS FERRY RESCUE UNIT FUND

Provider Business Mailing Address
First Line	:	40 FIRST STREET SE
Second Line	:
City	:	WAUKON
State	:	IA
Zip	:	52172-2022
Country	:	US
Telephone Number	:	563-568-3411
Fax Number	:	563-568-6139

Provider Business Practice Location Address
First Line	:	133 N 4TH ST
Second Line	:
City	:	HARPERS FERRY
State	:	IA
Zip	:	52146-9601
Country	:	US
Telephone Number	:	563-586-2556
Fax Number	:	563-586-2556

Authorized Official
Title or Position	:	COORDINATOR
Name	:	BECKY EILEEN BENZING
Credential	:	EMT-B
Telephone Number	:	563-586-2168

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	01/26/2009

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