Organization
MEDIVAC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MILLER (GENERAL MANAGER)
(712) 755-3800
Entity
Organization
Contact information
Practice address
812 CYCLONE AVE, HARLAN, IA 51537-1300
(712) 755-3800
(712) 755-7151
Mailing address
812 CYCLONE AVE, P.O. BOX 348, HARLAN, IA 51537-1300
(712) 755-3800
(712) 755-7151
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
2830700
IA
3416L0300X
Land Ambulance
5105
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0161711
—
IA
01
—
16171
WELLMARK BCBS
IA
Enumeration date
06/28/2005
Last updated
11/12/2009
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