Provider Demographics
NPI:1508826538
Name:CITY OF PONCA
Entity type:Organization
Organization Name:CITY OF PONCA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESCUE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-218-4392
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 1:111 S NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-7286
Practice Address - Country:US
Practice Address - Phone:877-218-4392
Practice Address - Fax:877-343-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09376OtherBLUE CROSS PROVIDER NO
NE09376OtherBLUE CROSS PROVIDER NO
NE09376OtherBLUE CROSS PROVIDER NO