Provider Demographics
NPI:1568577682
Name:BRULE VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:BRULE VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREA
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-287-2442
Mailing Address - Street 1:519 EAST 3RD STREET
Mailing Address - Street 2:P O BOX 194
Mailing Address - City:BRULE
Mailing Address - State:NE
Mailing Address - Zip Code:69127-0194
Mailing Address - Country:US
Mailing Address - Phone:308-287-2118
Mailing Address - Fax:
Practice Address - Street 1:519 EAST 3RD ST
Practice Address - Street 2:519 EAST 3RD ST
Practice Address - City:BRULE
Practice Address - State:NE
Practice Address - Zip Code:69127-0194
Practice Address - Country:US
Practice Address - Phone:308-287-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1311146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty