City of Johnston

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

2770800 Issued in IA

Legal business name

CITY OF JOHNSTON

Practice address

6015 NW 62ND Avenue
Johnston, IA 50131-0410

Phone

(515) 276-5182

Fax

(515) 334-5390

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Jim Krohse

Title

Fire Chief

Phone

(515) 276-5182

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1942214218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600900457",
            "telephone_number": "847-577-8811",
            "fax_number": "847-577-7967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6015 NW 62ND AVENUE",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501310410",
            "telephone_number": "515-276-5182",
            "fax_number": "515-334-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF JOHNSTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KROHSE",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "515-276-5182"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IA",
            "license": "2770800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "09411",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0487959",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CHOICE",
            "identifier": "09411",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE ACCESS",
            "identifier": "09411",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE ADVANTAGE",
            "identifier": "09411",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Keri Clark, LISW

• Land Ambulance in Johnston, IA
• Providers in Johnston, IA by specialty
• Land Ambulance in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.