Healthcare Provider Details

I. General information

NPI: 1891947503
Provider Name (Legal Business Name): CITY OF FULLERTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 05/02/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N FULLER
FULLERTON NE
68638
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: 877-218-4392
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1125
License Number StateNE

VIII. Authorized Official

Name: MR. ALLEN CHLOPEK
Title or Position: CITY ADMINISTRATOR
Credential:
Phone: 308-536-2428