MEDICARE: LOUP CITY, ASHTON & ROCKVILLE COOPERATIVE AMBULANCE SERVICE

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	3416L0300X	Land Ambulance	1017	NE
2	3416L0300X	Land Ambulance	1178	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09378	OTHER		BCBS

General Provider Information

NPI Number	:	1346466620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUP CITY, ASHTON & ROCKVILLE COOPERATIVE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	10802 FARNAM DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-3237
Country	:	US
Telephone Number	:	877-218-4392
Fax Number	:	877-343-0131

Provider Business Practice Location Address
First Line	:	940 P ST
Second Line	:
City	:	LOUP CITY
State	:	NE
Zip	:	68853-8006
Country	:	US
Telephone Number	:	308-745-0338
Fax Number	:

Authorized Official
Title or Position	:	ASST. CAPTAIN
Name	:	MR. TJADE RODOCKER
Credential	:
Telephone Number	:	308-645-7209

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/19/2024

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