Healthcare Provider Details

I. General information

NPI: 1205029121
Provider Name (Legal Business Name): WILCOX RURAL FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SO MAIN
WILCOX NE
68982
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 Number1328
License Number StateNE

VIII. Authorized Official

Name: MR. BRIAN P KONERT
Title or Position: AMBULANCE CHIEF
Credential:
Phone: 402-572-4019