Provider Demographics
NPI:1366402307
Name:TOWN OF SILVER CITY
Entity type:Organization
Organization Name:TOWN OF SILVER CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-740-7996
Mailing Address - Street 1:417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51571-3001
Mailing Address - Country:US
Mailing Address - Phone:712-527-2093
Mailing Address - Fax:712-527-4709
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:IA
Practice Address - Zip Code:51571-3001
Practice Address - Country:US
Practice Address - Phone:712-527-2093
Practice Address - Fax:712-527-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26503003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0207282Medicaid
IA06905OtherBLUE CROSS PROVIDER NO
06905Medicare PIN