MEDICARE: CITY OF OAKLAND

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	124	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590000436	OTHER		RAILROAD MEDICARE PROVIDE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09301	OTHER	NE	BLUE CROSS PROVIDER NO

General Provider Information

NPI Number	:	1992719215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF OAKLAND

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	:	500 N OAKLAND AVE
Second Line	:
City	:	OAKLAND
State	:	NE
Zip	:	68045-1137
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:	402-965-8594

Authorized Official
Title or Position	:	RESCUE CHIEF
Name	:	DAN JACOBS
Credential	:
Telephone Number	:	402-572-4019

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	11/13/2008

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Directions to “CITY OF OAKLAND ” Practice Location

Language	Start Address	Practice Location

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