Provider Demographics
NPI:1619296043
Name:COUNTY OF LOUP
Entity Type:Organization
Organization Name:COUNTY OF LOUP
Other - Org Name:LOUP COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-214-1058
Mailing Address - Street 1:403 CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:NE
Mailing Address - Zip Code:68814-2723
Mailing Address - Country:US
Mailing Address - Phone:308-935-1569
Mailing Address - Fax:308-935-9131
Practice Address - Street 1:407 3RD STREET
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:NE
Practice Address - Zip Code:68879
Practice Address - Country:US
Practice Address - Phone:308-942-9495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport