MEDICARE: CITY OF MITCHELL

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	341600000X	Ambulance	5036	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39410	OTHER	NE	BCBS PROVIDER #

General Provider Information

NPI Number	:	1669449781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF MITCHELL

Provider Business Mailing Address
First Line	:	422 S BELTLINE HWY E
Second Line	:
City	:	SCOTTSBLUFF
State	:	NE
Zip	:	69361-3501
Country	:	US
Telephone Number	:	308-635-0511
Fax Number	:	308-635-0164

Provider Business Practice Location Address
First Line	:	1145 CENTER AVE
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1442
Country	:	US
Telephone Number	:	308-623-1523
Fax Number	:

Authorized Official
Title or Position	:	BILLING AGENT
Name	:	MR. SHAWN BAUMGARTNER
Credential	:	NREMT-P
Telephone Number	:	308-635-0511

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/22/2020

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Directions to “CITY OF MITCHELL ” Practice Location

Language	Start Address	Practice Location

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