1508048067 NPI number — KANSAS AMBULANCE CO

Table of content: DR. CHARLOTTE ANN WALSTON D.D.S. (NPI 1912903196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508048067 NPI number — KANSAS AMBULANCE CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KANSAS AMBULANCE CO
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:
1508048067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 N FRONT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-682-5280
Provider Business Mailing Address Fax Number:
309-682-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 N FRONT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-682-5280
Provider Business Practice Location Address Fax Number:
309-682-5327
Provider Enumeration Date:
11/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
309-682-5280

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1746453 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0002332003 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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