Provider Demographics
NPI:1538203922
Name:TOWN OF COLUMBUS JCT.
Entity type:Organization
Organization Name:TOWN OF COLUMBUS JCT.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:INGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:319-728-7740
Mailing Address - Street 1:105 GAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS JUNCTION
Mailing Address - State:IA
Mailing Address - Zip Code:52738
Mailing Address - Country:US
Mailing Address - Phone:319-728-7740
Mailing Address - Fax:319-728-8010
Practice Address - Street 1:105 GAMBLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738
Practice Address - Country:US
Practice Address - Phone:319-728-7740
Practice Address - Fax:319-728-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207PE0004X, 3416L0300X
IA02580100341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
No3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0071738Medicaid
IA0071738Medicaid