Provider Demographics
NPI:1316942543
Name:VILLAGE OF MERNA
Entity type:Organization
Organization Name:VILLAGE OF MERNA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VILLAGE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-643-2281
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:308-935-1569
Practice Address - Street 1:425 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MERNA
Practice Address - State:NE
Practice Address - Zip Code:68856
Practice Address - Country:US
Practice Address - Phone:308-643-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1189341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid