Provider Demographics
NPI:1942444187
Name:PLYMOUTH RURAL FIRE PROTECTION DISTRICT NO. 5
Entity Type:Organization
Organization Name:PLYMOUTH RURAL FIRE PROTECTION DISTRICT NO. 5
Other - Org Name:PLYMOUTH AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VORDERSTRASSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-239-6579
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:531-895-5853
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:405 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68424-4104
Practice Address - Country:US
Practice Address - Phone:877-218-4392
Practice Address - Fax:877-343-0131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLYMOUTH RURAL FIRE PROTETION DISTRICT NO. 5
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEEMS12413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073770100Medicaid
091798Medicare PIN
NE091798Medicare PIN