Provider Demographics
NPI:1396860680
Name:PLYMOUTH AMB RURAL FIRE
Entity Type:Organization
Organization Name:PLYMOUTH AMB RURAL FIRE
Other - Org Name:PLYMOUTH AMBULANCE RURAL FIRE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:POHLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-656-3823
Mailing Address - Street 1:112 SOUTH JEFFERSON AVE.
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68424-0262
Mailing Address - Country:US
Mailing Address - Phone:402-656-3734
Mailing Address - Fax:
Practice Address - Street 1:112 SOUTH JEFFERSON AVE.
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68424-0262
Practice Address - Country:US
Practice Address - Phone:402-656-3734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3416L0300X
NEEMS12413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073770100Medicaid
091798Medicare PIN
NE091798Medicare PIN