Organization
TOWN OF PETERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE SMITH (ACCOUNT MANAGER)
(877) 882-9911
Entity
Organization
Contact information
Practice address
101 MAIN ST, PETERSON, IA 51047-7709
(712) 295-6401
(712) 295-6705
Mailing address
101 MAIN ST, PETERSON, IA 51047-7709
(712) 295-6401
(712) 295-6705
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
2210200
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0235432
—
IA
01
—
19206
BLUE CROSS
IA
Enumeration date
11/24/2006
Last updated
03/02/2012
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