1619003662 NPI number — EDGAR VOLUNTEER FIRE DEPT

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 1619003662 NPI number — EDGAR VOLUNTEER FIRE DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGAR VOLUNTEER FIRE DEPT
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:
Provider Other Organization Name Type Code:
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:
1619003662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

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:
531-895-5853
Provider Business Mailing Address Fax Number:
877-343-0131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 BEECH ST
Provider Second Line Business Practice Location Address:
BOX 123
Provider Business Practice Location Address City Name:
EDGAR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54426-0123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-352-2892
Provider Business Practice Location Address Fax Number:
715-352-2892
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALVORSEN
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS BILLING SECRETARY
Authorized Official Telephone Number:
531-895-5853

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  6000119 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000081761 . This is a "MEDICARE PROVIDER PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 3416L0300X . This is a "MEDICAID TAXONOMY CODE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41327500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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