1407846223 NPI number — CRAIG RURAL FIRE DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407846223 NPI number — CRAIG RURAL FIRE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG RURAL FIRE DISTRICT
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:
CRAIG RESCUE UNIT
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:
1407846223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2590 COUNTY ROAD H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEKAMAH
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68061-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-572-4019
Provider Business Mailing Address Fax Number:
402-965-8594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRAIG
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-572-4019
Provider Business Practice Location Address Fax Number:
402-965-8594
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHANSEN
Authorized Official First Name:
CHERI
Authorized Official Middle Name:
Authorized Official Title or Position:
RESCUE CAPTAIN
Authorized Official Telephone Number:
402-870-1711

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1078 , 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: 09361 . This is a "BLUE CROSS PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10025014700 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590012571 . This is a "RAILROAD MEDICARE PROVIDE" identifier . This identifiers is of the category "OTHER".




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