Provider Demographics
NPI:1275675365
Name:KENNARD VOLUNTEER FIRE RESCUE SQUAD
Entity Type:Organization
Organization Name:KENNARD VOLUNTEER FIRE RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:MAREE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-533-3596
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:531-895-5853
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:208 MAIN
Practice Address - Street 2:
Practice Address - City:KENNARD
Practice Address - State:NE
Practice Address - Zip Code:68034
Practice Address - Country:US
Practice Address - Phone:877-218-4392
Practice Address - Fax:877-343-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025044000Medicaid
NE39423OtherBLUE CROSS PROVIDER NO
590012703OtherRR MEDICARE PROVIDER NO
NE10025044000Medicaid