Provider Demographics
NPI:1669461653
Name:DECATUR RURAL FIRE DEPT.
Entity Type:Organization
Organization Name:DECATUR RURAL FIRE DEPT.
Other - Org Name:DECATUR VOL. FIRE AND RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:KYLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-313-9023
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:402-965-8594
Practice Address - Street 1:1012 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:NE
Practice Address - Zip Code:68020-2095
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025095200Medicaid
NE1091OtherSQUAD LICENSE
09304OtherBLUE CROSS PROVIDER NO
NE10025095200Medicaid