Basic Information
| Provider Information | |||||||||
| NPI: | 1750509279 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADAMS COUNTY AMBULANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 603 ROSARY DR | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508411683 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 603 ROSARY DR | ||||||||
| Address2: | |||||||||
| City: | CORNING | ||||||||
| State: | IA | ||||||||
| PostalCode: | 508411683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6413226273 | ||||||||
| FaxNumber: | 6413223616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2007 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | PECKHAM | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6413226273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 2020200 | IA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0251355 | 05 | IA | MEDICAID |