=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386729986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF EDGAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 02/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 5TH STREET
-----------------------------------------------------
City | EDGAR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-224-3005
-----------------------------------------------------
Fax | 402-408-2888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 485 105 5TH STREET
-----------------------------------------------------
City | EDGAR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68935-0485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-224-5145
-----------------------------------------------------
Fax | 402-224-3055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING CLERK
-----------------------------------------------------
Name | MRS. BARBARA A GRABHORN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-224-5145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1103
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------