MEDICARE: VILLAGE OF OVERTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	1222	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	NE	BCBS PROVIDER ENROLLMENT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205910544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF OVERTON

Provider Business Mailing Address
First Line	:	10802 FARNAM DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-3237
Country	:	US
Telephone Number	:	531-895-5853
Fax Number	:	877-343-0131

Provider Business Practice Location Address
First Line	:	502 D. STREET
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Authorized Official
Title or Position	:	ASST. CHIEF
Name	:	MR. JOEL D BEAVERS
Credential	:
Telephone Number	:	531-895-5853

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/28/2025

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Directions to “VILLAGE OF OVERTON ” Practice Location

Language	Start Address	Practice Location

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