Provider Demographics
NPI:1487746657
Name:VILLAGE OF WESTERN
Entity type:Organization
Organization Name:VILLAGE OF WESTERN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-433-4551
Mailing Address - Street 1:P.O. BOX 446
Mailing Address - Street 2:107 N. WEST AVENUE
Mailing Address - City:WESTERN
Mailing Address - State:NE
Mailing Address - Zip Code:68464-0446
Mailing Address - Country:US
Mailing Address - Phone:402-433-4551
Mailing Address - Fax:
Practice Address - Street 1:107 N. WEST AVENUE
Practice Address - Street 2:
Practice Address - City:WESTERN
Practice Address - State:NE
Practice Address - Zip Code:68464-0446
Practice Address - Country:US
Practice Address - Phone:402-433-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE091812Medicare PIN