1659376176 NPI number — GRAND RIVER REGIONAL 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 1659376176 NPI number — GRAND RIVER REGIONAL AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND RIVER REGIONAL 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:
6
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:
1659376176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANBERRY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-783-2430
Provider Business Mailing Address Fax Number:
660-783-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GRAND RIVER REGIONAL AMBULANCE DISTRICT
Provider Second Line Business Practice Location Address:
810 N ALANTHUS AVE.
Provider Business Practice Location Address City Name:
STANBERRY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-783-2430
Provider Business Practice Location Address Fax Number:
660-783-2804
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEGMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MAY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
660-783-2430

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  075035 , 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: 16949018 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 802478701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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