Provider Demographics
NPI:1477558625
Name:CALLAWAY VOLUNTEER FIRE & RESCUE DEPARTMENT
Entity Type:Organization
Organization Name:CALLAWAY VOLUNTEER FIRE & RESCUE DEPARTMENT
Other - Org Name:CALLAWAY RFD AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-304-4954
Mailing Address - Street 1:403 CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:NE
Mailing Address - Zip Code:68814-2723
Mailing Address - Country:US
Mailing Address - Phone:308-935-1569
Mailing Address - Fax:308-935-9131
Practice Address - Street 1:112 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825-2599
Practice Address - Country:US
Practice Address - Phone:308-836-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1048341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066364700Medicaid
NE09394OtherBLUECROSS
NE=========00Medicaid