Provider Demographics
NPI:1447327630
Name:CITY OF ROCKWELL CITY
Entity type:Organization
Organization Name:CITY OF ROCKWELL CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-297-7199
Mailing Address - Street 1:335 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579-1536
Mailing Address - Country:US
Mailing Address - Phone:712-297-7041
Mailing Address - Fax:712-297-5626
Practice Address - Street 1:335 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1536
Practice Address - Country:US
Practice Address - Phone:712-297-7041
Practice Address - Fax:712-297-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21307003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14138OtherBCBS
IA0141382Medicaid
IA14138Medicare ID - Type Unspecified