Provider Demographics
NPI:1134371040
Name:CITY OF KENESAW
Entity type:Organization
Organization Name:CITY OF KENESAW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VILLAGE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-572-4019
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:KENESAW
Mailing Address - State:NE
Mailing Address - Zip Code:68956-0350
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:115 E MAPLE
Practice Address - Street 2:
Practice Address - City:KENESAW
Practice Address - State:NE
Practice Address - Zip Code:68956
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:2008-10-22
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09353OtherBLUE CROSS PROVIDER
NE=========00Medicaid
091793Medicare PIN