Organization
SUPERIOR AMBULANCE LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY JOHNSTON (EMS DIRECTOR)
(319) 768-4764
Entity
Organization
Contact information
Practice address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
(319) 768-4764
(319) 768-3607
Mailing address
1221 S GEAR AVE, WEST BURLINGTON, IA 52655-1679
(319) 768-4764
(319) 768-3607
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
2290600
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0223214
IOWA HEALTH SOLUTIONS
IA
05
—
0223214
—
IA
01
—
24347
BLUE CROSS OF IOWA
IA
01
—
24347
BLUE CROSS FEDERAL
—
Enumeration date
12/13/2005
Last updated
08/22/2020
Update your record
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