Provider Demographics
NPI:1154584639
Name:CITY OF BELLEVUE
Entity type:Organization
Organization Name:CITY OF BELLEVUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-591-4530
Mailing Address - Street 1:1500 WALL ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-5299
Mailing Address - Country:US
Mailing Address - Phone:402-591-4530
Mailing Address - Fax:402-293-3079
Practice Address - Street 1:211 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5072
Practice Address - Country:US
Practice Address - Phone:402-591-4530
Practice Address - Fax:402-293-3079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BELLEVUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-06
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0401618Medicaid
NE10025650800Medicaid
614464000OtherUS DOL FECA
NE39466OtherBLUECROSS BLUESHIELD
NE39466OtherBCBS
IA0401618Medicaid
NE10025650800Medicaid