MEDICARE: CITY OF PLATTSMOUTH

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	5115	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590121138	OTHER		RAILROAD MEDICARE NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	09453	OTHER	NE	BLUE CROSS PROVIDER NO

General Provider Information

NPI Number	:	1982664215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF PLATTSMOUTH

Provider Business Mailing Address
First Line	:	136 NORTH 5TH ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048
Country	:	US
Telephone Number	:	402-296-6041
Fax Number	:	402-296-2391

Provider Business Practice Location Address
First Line	:	127 NORTH 5TH ST
Second Line	:
City	:	PLATTSMOUTH
State	:	NE
Zip	:	68048
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Authorized Official
Title or Position	:	DIRECTOR OF EMS
Name	:	MICHAEL P WOOD
Credential	:	NREMT-P
Telephone Number	:	402-296-6041

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/16/2017

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Directions to “CITY OF PLATTSMOUTH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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