Provider Demographics
NPI:1841325198
Name:EUSTIS RESCUE SQUAD
Entity type:Organization
Organization Name:EUSTIS RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-486-2531
Mailing Address - Street 1:P.O. BOX 91
Mailing Address - Street 2:101 E CHANDLER ST
Mailing Address - City:EUSTIS
Mailing Address - State:NE
Mailing Address - Zip Code:69028-0091
Mailing Address - Country:US
Mailing Address - Phone:308-486-4951
Mailing Address - Fax:
Practice Address - Street 1:101 E CHANDLER ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:NE
Practice Address - Zip Code:69028-0091
Practice Address - Country:US
Practice Address - Phone:308-486-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47600618000Medicaid
NE09418OtherBCBS OF NE
476006180OtherTRICARE
NE09418OtherBCBS OF NE