=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447456249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF SYRACUSE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 05/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 578 MOHAWK ST
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68446-9313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-269-2173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10802 FARNAM DR
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68154-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-895-5853
-----------------------------------------------------
Fax | 877-343-0131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | TIMOTHY A WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-440-5573
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1290
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------