Provider Demographics
NPI:1447211834
Name:CITY OF WOOD RIVER
Entity Type:Organization
Organization Name:CITY OF WOOD RIVER
Other - Org Name:WOOD RIVER RESCUE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:NE
Mailing Address - Zip Code:68883-0008
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:1002 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:NE
Practice Address - Zip Code:68883-3107
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09269OtherBLUE CROSS PROVIDER NO
NE09269OtherBLUE CROSS PROVIDER NO
NE=========00Medicaid