Provider Demographics
NPI:1598848558
Name:CITY OF WAKEFIELD
Entity Type:Organization
Organization Name:CITY OF WAKEFIELD
Other - Org Name:WAKEFIELD RESCUE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESCUE CAPT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEREAA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SODERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-369-1526
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:
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-6025
Practice Address - Country:US
Practice Address - Phone:402-287-2953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF WAKEFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4760640100Medicaid
NE9495OtherBC/BS OF NEBRASKA