Provider Demographics
NPI:1750014981
Name:CITY OF PELLA
Entity type:Organization
Organization Name:CITY OF PELLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HIGGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:641-628-1780
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-0385
Mailing Address - Country:US
Mailing Address - Phone:641-628-1780
Mailing Address - Fax:641-628-1478
Practice Address - Street 1:604 MAIN ST
Practice Address - Street 2:PELLA
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219
Practice Address - Country:US
Practice Address - Phone:641-628-1780
Practice Address - Fax:641-628-1478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF PELLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-06
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3416L0300XOtherTAXONOMY