Provider Demographics
NPI:1093748212
Name:CITY OF GRAND ISLAND
Entity Type:Organization
Organization Name:CITY OF GRAND ISLAND
Other - Org Name:GRAND ISLAND FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIVISION CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:308-389-0227
Mailing Address - Street 1:PO BOX 1968
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-1968
Mailing Address - Country:US
Mailing Address - Phone:308-385-5444
Mailing Address - Fax:308-385-5423
Practice Address - Street 1:100 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6023
Practice Address - Country:US
Practice Address - Phone:308-385-5444
Practice Address - Fax:308-385-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5022146L00000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
590121529OtherRRMCR
NE=========00Medicaid
590121529OtherRRMCR