1720017684 NPI number — OTO COMMUNITY AMBULANCE SERVICE

Table of content: CYNTHIA SUZETTE HAUGSDAL RN CNP (NPI 1649259904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720017684 NPI number — OTO COMMUNITY AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OTO COMMUNITY 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:
1720017684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51044-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-840-1447
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51044-7705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-840-1447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT REPRESENTATIVE
Authorized Official Telephone Number:
877-882-9911

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2972100 , 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: 0210278 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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