City of Eagle Grove

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2990300 Issued in IA

Legal business name

CITY OF EAGLE GROVE

Doing business as

City of Eagle Grove Ambulance Service

Practice address

210 E Broadway St
Eagle Grove, IA 50533-1813

Phone

(515) 448-4686

Fax

(515) 448-3761

NPI assigned

Nov 17, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matt Madson

Title

EMS Director

Phone

(515) 448-4686

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CITY OF EAGLE GROVE AMBULANCE SERVICE Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093889644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 165",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505330165",
            "telephone_number": "515-448-4686",
            "fax_number": "515-448-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E BROADWAY ST",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505331813",
            "telephone_number": "515-448-4686",
            "fax_number": "515-448-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF EAGLE GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MADSON",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "515-448-4686"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IA",
            "license": "2990300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0057059",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITY OF EAGLE GROVE AMBULANCE SERVICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janet E B Bade, RPH
• Broadway Vision Source, Incorporated
• Gregory Jon Burmeister, D.C.
• Coleman Counseling, Inc.
• Jill Coleman
• Community Health Center of Fort Dodge, Inc. (Community Health Center of Eagle Grove)
• Michele Diane Cooper, RPH
• Eagle Grove C.S.D.

• Land Ambulance in Eagle Grove, IA
• Providers in Eagle Grove, IA by specialty
• Land Ambulance in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.