Provider Demographics
NPI:1053440875
Name:PERCIVAL VOLUNTEER FIREMENT INC.
Entity Type:Organization
Organization Name:PERCIVAL VOLUNTEER FIREMENT INC.
Other - Org Name:PERCIVAL FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-374-2010
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:402-991-0719
Practice Address - Street 1:2065 195TH AVE
Practice Address - Street 2:
Practice Address - City:PERCIVAL
Practice Address - State:IA
Practice Address - Zip Code:51648-6010
Practice Address - Country:US
Practice Address - Phone:712-529-4218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0474528Medicaid