1548266208 NPI number — GLENWOOD VOLUNTEER FIRE ASSOC INC

Table of content: (NPI 1548266208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548266208 NPI number — GLENWOOD VOLUNTEER FIRE ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENWOOD VOLUNTEER FIRE ASSOC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GLENWOOD FIRE RESCUE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548266208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENWOOD
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51534-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-527-2093
Provider Business Mailing Address Fax Number:
712-527-4709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51534-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-527-2093
Provider Business Practice Location Address Fax Number:
712-527-4709
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FIDLER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING CORRDINATOR
Authorized Official Telephone Number:
712-527-2093

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2650700 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590014576 . This is a "PALMETTO GBA RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 52539 . This is a "FED BLUE CROSS BLUE SHIEL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 49395 . This is a "BLUE CROSS BLUE SHIELD IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0252486 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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