Provider Demographics
NPI:1790065878
Name:SYRACUSE RESCUE SERVICE
Entity Type:Organization
Organization Name:SYRACUSE RESCUE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:308-440-5573
Mailing Address - Street 1:572 MOHAWK ST
Mailing Address - Street 2:PO BOX 225
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-9313
Mailing Address - Country:US
Mailing Address - Phone:402-269-2111
Mailing Address - Fax:402-269-2111
Practice Address - Street 1:572 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-9313
Practice Address - Country:US
Practice Address - Phone:402-269-2111
Practice Address - Fax:402-269-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1290341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid