Provider Demographics
NPI:1871277905
Name:JEFFERSON COUNTY
Entity type:Organization
Organization Name:JEFFERSON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-209-3610
Mailing Address - Street 1:1900 W BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2628
Mailing Address - Country:US
Mailing Address - Phone:641-209-3610
Mailing Address - Fax:641-209-3611
Practice Address - Street 1:1900 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2628
Practice Address - Country:US
Practice Address - Phone:641-209-3610
Practice Address - Fax:641-209-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty