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:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-895-5853
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:531-895-5853
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:355 MANDERSON ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NE
Practice Address - Zip Code:68821-9999
Practice Address - Country:US
Practice Address - Phone:877-218-4392
Practice Address - Fax:877-343-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2024-10-07
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=========Medicaid
NENA1715Medicare PIN