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General NPI Number Information
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NPI Number | 1710956248
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Entity Type | Organization
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Legal Business Name | CITY OF BROKEN BOW
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1848 S G ST
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City | BROKEN BOW
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State | NE
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Zip | 68822-1825
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Country | US
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Telephone | 308-872-1253
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Fax | 308-872-2173
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Provider Business Mailing Address
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Address Line | 1848 S G ST
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City | BROKEN BOW
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State | NE
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Zip | 68822-1825
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Country | US
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Telephone | 308-872-1253
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Fax | 308-767-2651
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Authorized Official
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Title or Position | EMERGENCY SERVICE DIRECTOR
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Name | ANDY CALVIN HOLLAND
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Credential |
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Telephone | 308-872-1253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1065
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License Number State | NE
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