1083776686 NPI number — RURAL-METRO MID-SOUTH LP

Table of content: (NPI 1083776686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083776686 NPI number — RURAL-METRO MID-SOUTH LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL-METRO MID-SOUTH LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083776686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 731048
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-889-1581
Provider Business Mailing Address Fax Number:
317-781-6198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-1000
Provider Business Practice Location Address Fax Number:
573-686-6877
Provider Enumeration Date:
12/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAN HORNE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
682-227-6078

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  023086 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806328407 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".