Provider Demographics
NPI:1366596736
Name:CITY OF CLIVE
Entity type:Organization
Organization Name:CITY OF CLIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-223-6220
Mailing Address - Street 1:8800 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5338
Mailing Address - Country:US
Mailing Address - Phone:515-223-1595
Mailing Address - Fax:
Practice Address - Street 1:8505 HARBACH BLVD
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1077
Practice Address - Country:US
Practice Address - Phone:515-223-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27703003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07315OtherWELLMARK BC BS NUMBER
IA0081562Medicaid
IA590007264Medicare ID - Type UnspecifiedMEDICARE RAILROAD NUMBER
IA0081562Medicaid