Healthcare Provider Details

I. General information

NPI: 1962589762
Provider Name (Legal Business Name): PONCA HILLS VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12919 PONCA RD
OMAHA NE
68112-1056
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-4019
  • Fax: 402-965-8594
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-965-8594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number5110
License Number StateNE

VIII. Authorized Official

Name: JOEL E SACKS
Title or Position: FIRE CHIEF
Credential:
Phone: 402-572-4019