Healthcare Provider Details

I. General information

NPI: 1285899609
Provider Name (Legal Business Name): CITY OF SUTTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W GROVE ST
SUTTON NE
68979-0430
US

IV. Provider business mailing address

107 W GROVE ST PO BOX 430
SUTTON NE
68979-0430
US

V. Phone/Fax

Practice location:
  • Phone: 402-773-5607
  • Fax: 402-773-5501
Mailing address:
  • Phone: 402-773-5607
  • Fax: 402-773-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number091785
License Number StateNE

VIII. Authorized Official

Name: MRS. LANA K EBERT
Title or Position: UBCLERK
Credential:
Phone: 402-773-5607