Provider Demographics
NPI:1609869304
Name:CROFTON VOLUNTEER AMBULANCE
Entity Type:Organization
Organization Name:CROFTON VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAVADIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-388-4110
Mailing Address - Street 1:204 W WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-3200
Mailing Address - Country:US
Mailing Address - Phone:402-388-4110
Mailing Address - Fax:402-388-4579
Practice Address - Street 1:204 W WYOMING ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:NE
Practice Address - Zip Code:68730-3200
Practice Address - Country:US
Practice Address - Phone:402-388-4110
Practice Address - Fax:402-388-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47600615500Medicaid
NE=========00Medicaid
091801Medicare PIN
NE47600615500Medicaid