Provider Demographics
NPI:1205825981
Name:CITY OF FREMONT
Entity Type:Organization
Organization Name:CITY OF FREMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-2622
Mailing Address - Street 1:400 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5141
Mailing Address - Country:US
Mailing Address - Phone:402-727-2622
Mailing Address - Fax:402-727-2617
Practice Address - Street 1:415 E 16TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3446
Practice Address - Country:US
Practice Address - Phone:402-727-2688
Practice Address - Fax:402-727-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0557215Medicaid
NV100506886Medicaid
NE=========00Medicaid
NE=========OtherCHAMPUS/TRICARE
NE=========OtherCHAMPUS/TRICARE
IA0557215Medicaid