Provider Demographics
NPI:1235271073
Name:VILLAGE OF PETERSBURG
Entity type:Organization
Organization Name:VILLAGE OF PETERSBURG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FANGMAN
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 1:226 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:NE
Practice Address - Zip Code:68652
Practice Address - Country:US
Practice Address - Phone:402-386-5287
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014780OtherRR MEDICARE PROVIDER NO
NE09312OtherBLUE CROSS PROVIDER NE
NE=========00Medicaid
NE09312OtherBLUE CROSS PROVIDER NE