Healthcare Provider Details

I. General information

NPI: 1912902818
Provider Name (Legal Business Name): BLAINE COUNTY RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MANDERSON ST
BREWSTER NE
68821-9999
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 877-218-4392
  • Fax: 877-343-0131
Mailing address:
  • Phone: 531-895-5853
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1035
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1035
License Number StateNE

VIII. Authorized Official

Name: CRISTIN FAY
Title or Position: CAPTAIN
Credential:
Phone: 531-895-5853