1093748212 NPI number — CITY OF GRAND ISLAND

Table of content: (NPI 1093748212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093748212 NPI number — CITY OF GRAND ISLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF GRAND ISLAND
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:
6
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:
1093748212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1968
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68802-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-385-5444
Provider Business Mailing Address Fax Number:
308-385-5423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68801-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-385-5444
Provider Business Practice Location Address Fax Number:
308-385-5423
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKBURN
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EMS DIVISION CHIEF
Authorized Official Telephone Number:
308-389-0227

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  5022 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 5022 , 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: 590121529 . This is a "RRMCR" identifier . This identifiers is of the category "OTHER".




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