Provider Demographics
NPI:1912902818
Name:BLAINE COUNTY RESCUE SQUAD
Entity Type:Organization
Organization Name:BLAINE COUNTY RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:
Authorized Official - Last Name:GLERUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-547-2400
Mailing Address - Street 1:403 CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:NE
Mailing Address - Zip Code:68814-2723
Mailing Address - Country:US
Mailing Address - Phone:308-935-1569
Mailing Address - Fax:308-935-9131
Practice Address - Street 1:145 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NE
Practice Address - Zip Code:68821-9700
Practice Address - Country:US
Practice Address - Phone:308-547-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1035341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39441OtherBLUECROSS
NE=========00Medicaid
NENA1715Medicare PIN