1154321040 NPI number — CHARITON COUNTY AMBULANCE DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154321040 NPI number — CHARITON COUNTY AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARITON COUNTY AMBULANCE DISTRICT
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:
1154321040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 SOUTH WEBER AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S WEBER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65281-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-388-6115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCKENZIE
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
660-388-6115

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  041009 , 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: 800628802 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".