Provider Demographics
NPI:1447325345
Name:TOWN OF PETERSON
Entity type:Organization
Organization Name:TOWN OF PETERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-882-9911
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSON
Mailing Address - State:IA
Mailing Address - Zip Code:51047-7709
Mailing Address - Country:US
Mailing Address - Phone:712-295-6401
Mailing Address - Fax:712-295-6705
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSON
Practice Address - State:IA
Practice Address - Zip Code:51047-7709
Practice Address - Country:US
Practice Address - Phone:712-295-6401
Practice Address - Fax:712-295-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2210200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19206OtherBLUE CROSS
IA0235432Medicaid
IAI4776Medicare PIN