1033430905 NPI number — MR. THOMAS EDWARD SNOWBALL SR. EMT-BASIC

Table of content: MR. THOMAS EDWARD SNOWBALL SR. EMT-BASIC (NPI 1033430905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033430905 NPI number — MR. THOMAS EDWARD SNOWBALL SR. EMT-BASIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOWBALL
Provider First Name:
THOMAS
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
EMT-BASIC
Provider Gender Code:
M

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:
1033430905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 772
Provider Second Line Business Mailing Address:
504 HOCHUNK PLAZA #3
Provider Business Mailing Address City Name:
WINNEBAGO
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-204-4717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 INDIAN HILLS DRIVE
Provider Second Line Business Practice Location Address:
OMAHA TRIBAL RESCUE 100 INDIAN HILLS DRIVE
Provider Business Practice Location Address City Name:
MACY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68039-0250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-837-5381
Provider Business Practice Location Address Fax Number:
402-837-5303
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  17965 , 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)





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