Superior Ambulance LC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2290600 Issued in IA

Legal business name

SUPERIOR AMBULANCE LC

Practice address

1221 S Gear Ave
West Burlington, IA 52655-1679

Phone

(319) 768-4764

Fax

(319) 768-3607

NPI assigned

Dec 13, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Jerry Johnston

Title

EMS Director

Phone

(319) 768-4764

Specialties & licenses 1

Addresses

Other identifiers 9

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730164633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S GEAR AVE",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551679",
            "telephone_number": "319-768-4764",
            "fax_number": "319-768-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S GEAR AVE",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551679",
            "telephone_number": "319-768-4764",
            "fax_number": "319-768-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR AMBULANCE LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "319-768-4764",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IA",
            "license": "2290600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IOWA",
            "identifier": "24347",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA HEALTH SOLUTIONS",
            "identifier": "0223214",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBC OF IOWA",
            "identifier": "0223214",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF IOWA",
            "identifier": "24347",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0223214",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "24347",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FEDERAL",
            "identifier": "24347",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE SELECT/BC/BS",
            "identifier": "24347",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS ALLIANCE SELECT",
            "identifier": "24347",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in West Burlington, IA
• Providers in West Burlington, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.