1578684783 NPI number — SABULA AMBULANCE SERVICE

Table of content: (NPI 1578684783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578684783 NPI number — SABULA AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SABULA AMBULANCE SERVICE
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:
Provider Other Organization Name Type Code:
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:
1578684783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 303
Provider Second Line Business Mailing Address:
201 VULCAN STREET
Provider Business Mailing Address City Name:
SABULA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52070-0303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-687-2432
Provider Business Mailing Address Fax Number:
563-687-2877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 VULCAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABULA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52070-0303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-687-2432
Provider Business Practice Location Address Fax Number:
563-687-2877
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACKERMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
563-687-2432

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  2490400 , 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: 421728331001 . This is a "ILLINOIS DEPT HEALTHCARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0064352 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00432298 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 21465 . This is a "BLUE CROSS BLUE SHIELD IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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