Healthcare Provider Details

I. General information

NPI: 1962560789
Provider Name (Legal Business Name): VILLAGE OF SUTHERLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 1ST ST
SUTHERLAND NE
69165-2104
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 308-386-8440
  • Fax: 877-343-0131
Mailing address:
  • Phone: 877-218-4392
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1288
License Number StateNE

VIII. Authorized Official

Name: ROGER LATHROP
Title or Position: FIRE CHIEF
Credential:
Phone: 308-386-8440