Healthcare Provider Details

I. General information

NPI: 1730184631
Provider Name (Legal Business Name): COMSTOCK RURAL FIRE DEPARTMENT AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45989 HIGHWAY S21C
COMSTOCK NE
68828-5134
US

IV. Provider business mailing address

403 CHATHAM AVE
BERWYN NE
68814
US

V. Phone/Fax

Practice location:
  • Phone: 308-215-0254
  • Fax:
Mailing address:
  • Phone: 308-935-1569
  • Fax: 308-935-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1074
License Number StateNE

VIII. Authorized Official

Name: PERRY ERICKSON
Title or Position: TREASURER
Credential:
Phone: 308-628-4340