Healthcare Provider Details

I. General information

NPI: 1447456249
Provider Name (Legal Business Name): CITY OF SYRACUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 MOHAWK ST
SYRACUSE NE
68446-9313
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 402-269-2173
  • Fax:
Mailing address:
  • Phone: 531-895-5853
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1290
License Number StateNE

VIII. Authorized Official

Name: TIMOTHY A WILSON
Title or Position: CHIEF
Credential:
Phone: 308-440-5573