Healthcare Provider Details

I. General information

NPI: 1598847105
Provider Name (Legal Business Name): CITY OF COZAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 8TH ST
COZAD NE
69130-1733
US

IV. Provider business mailing address

215 W 8TH ST
COZAD NE
69130-0309
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-3907
  • Fax: 308-784-3509
Mailing address:
  • Phone: 308-784-3907
  • Fax: 308-784-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1077
License Number StateNE

VIII. Authorized Official

Name: MRS. KELLY JEAN PEDEN
Title or Position: DEPUTY CLERK
Credential:
Phone: 308-784-3907