1437254349 NPI number — CITY OF FRIEND

Table of content: (NPI 1437254349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437254349 NPI number — CITY OF FRIEND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF FRIEND
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRIEND AMBULANCE SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437254349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/23/2008
NPI Reactivation Date:
12/19/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10802 FARNAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-218-4392
Provider Business Mailing Address Fax Number:
877-343-0131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIEND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68359-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-218-4392
Provider Business Practice Location Address Fax Number:
877-343-0131
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAULSEN
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
RESCUE CAPTAIN
Authorized Official Telephone Number:
402-416-1097

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  1122 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1122 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025676100 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09392 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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