Provider Demographics
NPI:1164646519
Name:CITY OF INDIANOLA
Entity type:Organization
Organization Name:CITY OF INDIANOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAU
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:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:210 NORTH 4TH
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:NE
Practice Address - Zip Code:69034
Practice Address - Country:US
Practice Address - Phone:308-364-2413
Practice Address - Fax:308-364-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE091874Medicare ID - Type Unspecified