Provider Demographics
NPI:1205035847
Name:CITY OF CLARKSON
Entity Type:Organization
Organization Name:CITY OF CLARKSON
Other - Org Name:CLARKSON RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAUMERT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:402-860-2286
Mailing Address - Street 1:220 BRYAN STREET
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:CLARKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68629
Mailing Address - Country:US
Mailing Address - Phone:402-892-3216
Mailing Address - Fax:
Practice Address - Street 1:220 BRYAN STREET
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:NE
Practice Address - Zip Code:68629
Practice Address - Country:US
Practice Address - Phone:402-892-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1068341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054271700Medicaid
091792OtherLEGACY NUMBER