MEDICARE: DAKOTA CITY VOLUNTEER FIRE DEPARTMENT INC. OF DAKOTA CITY, NEBRASKA

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590121425	OTHER	NE	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09266	OTHER	NE	BLUE CROSS PROVIDER NO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407845274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA CITY VOLUNTEER FIRE DEPARTMENT INC. OF DAKOTA CITY, NEBRASKA

Provider Business Mailing Address
First Line	:	PO BOX 641880
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7880
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Provider Business Practice Location Address
First Line	:	1516 MYRTLE ST
Second Line	:
City	:	DAKOTA CITY
State	:	NE
Zip	:	68731
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Authorized Official
Title or Position	:	RESCUE CAPTAIN
Name	:	PATRICK B MOORE
Credential	:
Telephone Number	:	402-987-3409

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	01/05/2018

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Directions to “DAKOTA CITY VOLUNTEER FIRE DEPARTMENT INC. OF DAKOTA CITY, NEBRASKA ” Practice Location

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