Provider Demographics
NPI:1376690453
Name:CITY OF CREIGHTON
Entity Type:Organization
Organization Name:CITY OF CREIGHTON
Other - Org Name:CREIGHTON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING LEADER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-571-4019
Mailing Address - Street 1:708 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-0188
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:1503 MAIN ST
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-0188
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09399OtherBLUE CROSS PROVIDER NO
NE09399OtherBLUE CROSS PROVIDER NO
091937Medicare PIN