Provider Demographics
NPI:1679645873
Name:CITY OF HUDSON
Entity type:Organization
Organization Name:CITY OF HUDSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:319-988-3322
Mailing Address - Street 1:525 JEFFERSON ST.
Mailing Address - Street 2:P. O. BOX 712
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-9717
Mailing Address - Country:US
Mailing Address - Phone:319-988-3322
Mailing Address - Fax:319-988-3247
Practice Address - Street 1:200 WATERLOO RD.
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IA
Practice Address - Zip Code:50643-9717
Practice Address - Country:US
Practice Address - Phone:319-988-3322
Practice Address - Fax:319-988-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2070500341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0005702Medicaid
IA00570OtherBCBS
IN590007396OtherRAILROAD
IA00570Medicare ID - Type Unspecified