Healthcare Provider Details

I. General information

NPI: 1568475622
Provider Name (Legal Business Name): NIOBRARA RURAL FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 SPRUCE AVE
NIOBRARA NE
68760-6102
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-4019
  • Fax: 402-991-0719
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-991-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1207
License Number StateNE

VIII. Authorized Official

Name: SHARON SCOTT
Title or Position: CAPTAIN
Credential:
Phone: 402-572-4019