Provider Demographics
NPI:1528184249
Name:CITY OF RANDOLPH
Entity Type:Organization
Organization Name:CITY OF RANDOLPH
Other - Org Name:RANDOLPH RESCUE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBBELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-360-3409
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NE
Mailing Address - Zip Code:68771-0143
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-991-0719
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NE
Practice Address - Zip Code:68771-0143
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-991-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========001OtherBLUE CROSS BLUE SHIELD
NE=========00Medicaid