1063494052 NPI number — CITY OF OLIN

Table of content: (NPI 1063494052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063494052 NPI number — CITY OF OLIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF OLIN
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:
OLIN AMBULANCE SERVICE
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:
1063494052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2715 FRANK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54703-2593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-642-9543
Provider Business Mailing Address Fax Number:
715-852-0620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W CLEVELAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52320-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-484-2875
Provider Business Practice Location Address Fax Number:
319-484-2875
Provider Enumeration Date:
11/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF AMBULANCE BOARD
Authorized Official Telephone Number:
319-484-2139

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2530500 , 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: 0085860 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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