Healthcare Provider Details

I. General information

NPI: 1619296043
Provider Name (Legal Business Name): COUNTY OF LOUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 7TH STREET
TAYLOR NE
68879
US

IV. Provider business mailing address

403 CHATHAM AVE
BERWYN NE
68814-2723
US

V. Phone/Fax

Practice location:
  • Phone: 308-942-9495
  • Fax:
Mailing address:
  • Phone: 308-935-1569
  • Fax: 308-935-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1179
License Number StateNE

VIII. Authorized Official

Name: LISA MOLESWORTH
Title or Position: VICE PRESIDENT/BILLING OFFICER
Credential:
Phone: 308-214-1058