Provider Demographics
NPI:1134132863
Name:FIRE PROTECTION DISTRICT 4
Entity Type:Organization
Organization Name:FIRE PROTECTION DISTRICT 4
Other - Org Name:POTTER VOLUNTEER FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-218-4392
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:900 FRONT ST
Practice Address - Street 2:
Practice Address - City:POTTER
Practice Address - State:NE
Practice Address - Zip Code:69156
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:2006-08-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39454OtherBLUE CROSS PROVIDER NO
P00045115OtherRR MEDICARE PROVIDER NO
P00045115OtherRR MEDICARE PROVIDER NO
NE=========00Medicaid