Provider Demographics
NPI:1568475150
Name:HALLAM VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:HALLAM VOLUNTEER FIRE DEPARTMENT
Other - Org Name:HALLAM RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:130 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:HALLAM
Practice Address - State:NE
Practice Address - Zip Code:68368
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:2006-08-14
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014600OtherRAILROAD MEDICARE PROVIDE
NE09413OtherBLUE CROSS PROVIDER NO
590014600OtherRAILROAD MEDICARE PROVIDE
NE=========00Medicaid