Provider Demographics
NPI:1548266208
Name:GLENWOOD VOLUNTEER FIRE ASSOC INC
Entity type:Organization
Organization Name:GLENWOOD VOLUNTEER FIRE ASSOC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING CORRDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:712-527-2093
Mailing Address - Street 1:120 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1741
Mailing Address - Country:US
Mailing Address - Phone:712-527-2093
Mailing Address - Fax:712-527-4709
Practice Address - Street 1:120 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1741
Practice Address - Country:US
Practice Address - Phone:712-527-2093
Practice Address - Fax:712-527-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2650700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA590014576OtherPALMETTO GBA RR MEDICARE
IA52539OtherFED BLUE CROSS BLUE SHIEL
IA49395OtherBLUE CROSS BLUE SHIELD IA
IA0252486Medicaid
IA52539OtherFED BLUE CROSS BLUE SHIEL