Provider Demographics
NPI:1134177819
Name:CLAY TOWNSHIP FIRE DEPARTMENT FIREFIGHTER
Entity type:Organization
Organization Name:CLAY TOWNSHIP FIRE DEPARTMENT FIREFIGHTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-629-9964
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:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:313 WOLTZ ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:IA
Practice Address - Zip Code:50256-8565
Practice Address - Country:US
Practice Address - Phone:641-949-6307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44857OtherBLUE CROSS
IA0156489Medicaid
IA=========OtherUNITED HEALTH CARE