Provider Demographics
NPI:1437254349
Name:CITY OF FRIEND
Entity Type:Organization
Organization Name:CITY OF FRIEND
Other - Org Name:FRIEND AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-416-1097
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:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:300 SPRING ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1424
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:2006-09-14
Last Update Date:2023-02-21
Deactivation Date:2008-09-23
Deactivation Code:
Reactivation Date:2008-12-19
Provider Licenses
StateLicense IDTaxonomies
NE1122146N00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025676100Medicaid
NE09392OtherBLUE CROSS BLUE SHIELD
NE10025676100Medicaid