Medivac Corp

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2830700 Issued in IA

Legal business name

MEDIVAC CORP

Practice address

812 Cyclone Ave
Harlan, IA 51537-1300

Phone

(712) 755-3800

Fax

(712) 755-7151

NPI assigned

Jun 28, 2005

Organization subpart

No

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

Authorized official

Name

Mr. David Miller

Title

General Manager

Phone

(712) 755-3800

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1215934849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 CYCLONE AVE",
            "address_2": "P.O. BOX 348",
            "city": "HARLAN",
            "state": "IA",
            "postal_code": "515371300",
            "telephone_number": "712-755-3800",
            "fax_number": "712-755-7151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 CYCLONE AVE",
            "city": "HARLAN",
            "state": "IA",
            "postal_code": "515371300",
            "telephone_number": "712-755-3800",
            "fax_number": "712-755-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIVAC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "712-755-3800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IA",
            "license": "2830700",
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NE",
            "license": "5105",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "16171",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0161711",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Harlan, IA
• Land Ambulance in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.