Provider Demographics
NPI:1598847105
Name:CITY OF COZAD
Entity Type:Organization
Organization Name:CITY OF COZAD
Other - Org Name:CITY OF COZAD AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-784-3907
Mailing Address - Street 1:215 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-0309
Mailing Address - Country:US
Mailing Address - Phone:308-784-3907
Mailing Address - Fax:308-784-3509
Practice Address - Street 1:215 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1733
Practice Address - Country:US
Practice Address - Phone:308-784-3907
Practice Address - Fax:308-784-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1077341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091773Medicaid
NE091773Medicare ID - Type Unspecified