Provider Demographics
NPI:1619095569
Name:COLERIDGE AMBULANCE SERVICE
Entity Type:Organization
Organization Name:COLERIDGE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF VILLAGE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-283-4464
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:217 EAST BROADWAY ST.
Mailing Address - City:COLERIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:68727-0276
Mailing Address - Country:US
Mailing Address - Phone:402-283-4464
Mailing Address - Fax:402-283-4464
Practice Address - Street 1:217 EAST BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:COLERIDGE
Practice Address - State:NE
Practice Address - Zip Code:68727-0276
Practice Address - Country:US
Practice Address - Phone:402-283-4464
Practice Address - Fax:402-283-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250807-00Medicaid
NE099531Medicare ID - Type Unspecified