Provider Demographics
NPI:1043326291
Name:ELK HORN RESCUE
Entity Type:Organization
Organization Name:ELK HORN RESCUE
Other - Org Name:ELK HORN FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:4147 MAIN
Practice Address - Street 2:
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28309003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0497164Medicaid
IA30643OtherBCBS PROVIDER NUMBER
IA30643OtherBCBS PROVIDER NUMBER