Provider Demographics
NPI:1629155403
Name:AXTELL RURAL FIRE DEPARTMENT NO 4
Entity Type:Organization
Organization Name:AXTELL RURAL FIRE DEPARTMENT NO 4
Other - Org Name:AXTELL VOL. FIRE AND RESCUE DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
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:402-991-0719
Practice Address - Street 1:202 E 6TH ST
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:NE
Practice Address - Zip Code:68924-3419
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-991-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39416OtherBLUE CROSS PROVIDER NO
NE47600608600Medicaid
NE39416OtherBLUE CROSS PROVIDER NO
NE099090Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO