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General NPI Number Information
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NPI Number | 1730184631
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Entity Type | Organization
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Legal Business Name | COMSTOCK RURAL FIRE DEPARTMENT AMBULANCE
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 45989 HIGHWAY S21C
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City | COMSTOCK
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State | NE
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Zip | 68828-5134
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Country | US
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Telephone | 308-215-0254
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Fax |
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Provider Business Mailing Address
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Address Line | 403 CHATHAM AVE
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City | BERWYN
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State | NE
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Zip | 68814
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Country | US
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Telephone | 308-935-1569
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Fax | 308-935-1569
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Authorized Official
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Title or Position | TREASURER
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Name | PERRY ERICKSON
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Credential |
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Telephone | 308-628-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 1074
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License Number State | NE
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