Healthcare Provider Details

I. General information

NPI: 1871657791
Provider Name (Legal Business Name): BENNINGTON VOLUNTEER FIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15509 WAREHOUSE STREET
BENNINGTON NE
68007
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-4019
  • Fax: 402-965-8594
Mailing address:
  • Phone: 402-571-4019
  • Fax: 402-965-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5100
License Number StateNE

VIII. Authorized Official

Name: LARRY DEAN ARP
Title or Position: EMS ACCT CHIEF
Credential:
Phone: 402-572-4019