1548266208 NPI number — GLENWOOD VOLUNTEER FIRE ASSOC INC

Table of Contents

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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