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General NPI Number Information
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NPI Number | 1790065878
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Entity Type | Organization
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Legal Business Name | SYRACUSE RESCUE SERVICE
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 572 MOHAWK ST
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City | SYRACUSE
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State | NE
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Zip | 68446-9313
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Country | US
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Telephone | 402-269-2111
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Fax | 402-269-2111
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Provider Business Mailing Address
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Address Line | 572 MOHAWK ST PO BOX 225
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City | SYRACUSE
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State | NE
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Zip | 68446-9313
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Country | US
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Telephone | 402-269-2111
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Fax | 402-269-2111
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Authorized Official
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Title or Position | CHIEF OF OPERATIONS
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Name | TIMOTHY A WILSON
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Credential | PARAMEDIC
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Telephone | 308-440-5573
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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 | 1290
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License Number State | NE
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