MEDICARE: CITY OF BRIDGEPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	1039	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	39409	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1093784399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF BRIDGEPORT

Provider Business Mailing Address
First Line	:	422 S BELTLINE HWY E
Second Line	:
City	:	SCOTTSBLUFF
State	:	NE
Zip	:	69361-3501
Country	:	US
Telephone Number	:	308-635-0511
Fax Number	:	308-635-0164

Provider Business Practice Location Address
First Line	:	809 MAIN ST
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-4046
Country	:	US
Telephone Number	:	308-635-0511
Fax Number	:	308-635-0164

Authorized Official
Title or Position	:	BILLING CLERK
Name	:	MR. SHAWN J BAUMGARTNER
Credential	:	NREMT-P
Telephone Number	:	308-635-0511

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/11/2010

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Directions to “CITY OF BRIDGEPORT ” Practice Location

Language	Start Address	Practice Location

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