Healthcare Provider Details

I. General information

NPI: 1386729986
Provider Name (Legal Business Name): CITY OF EDGAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 5TH STREET
EDGAR NE
68935
US

IV. Provider business mailing address

PO BOX 485 105 5TH STREET
EDGAR NE
68935-0485
US

V. Phone/Fax

Practice location:
  • Phone: 402-224-3005
  • Fax: 402-408-2888
Mailing address:
  • Phone: 402-224-5145
  • Fax: 402-224-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1103
License Number StateNE

VIII. Authorized Official

Name: MRS. BARBARA A GRABHORN
Title or Position: BILLING CLERK
Credential:
Phone: 402-224-5145