Provider Demographics
NPI:1770608747
Name:ALEXANDRIA RESCUE SERVICE
Entity type:Organization
Organization Name:ALEXANDRIA RESCUE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESCUE SQUAD CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-749-3215
Mailing Address - Street 1:56095 720TH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-5063
Mailing Address - Country:US
Mailing Address - Phone:402-749-3215
Mailing Address - Fax:
Practice Address - Street 1:207 3RD STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:NE
Practice Address - Zip Code:68303
Practice Address - Country:US
Practice Address - Phone:402-749-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1003146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid