Provider Demographics
NPI:1477542645
Name:CITY OF WAHOO
Entity Type:Organization
Organization Name:CITY OF WAHOO
Other - Org Name:WAHOO RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-217-8606
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 1:158 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1647
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:2005-10-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025282400Medicaid
NE5138OtherNE. STATE LICENSE
NE09409OtherBLUE CROSS PROVIDER NO
NE091837Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO