Provider Demographics
NPI:1093784399
Name:CITY OF BRIDGEPORT
Entity Type:Organization
Organization Name:CITY OF BRIDGEPORT
Other - Org Name:BRIDGEPORT EMS DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:308-635-0511
Mailing Address - Street 1:422 S BELTLINE HWY E
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3501
Mailing Address - Country:US
Mailing Address - Phone:308-635-0511
Mailing Address - Fax:308-635-0164
Practice Address - Street 1:809 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-4046
Practice Address - Country:US
Practice Address - Phone:308-635-0511
Practice Address - Fax:308-635-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1039341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025261100Medicaid
NE39409OtherBCBS
NE39409OtherBCBS