1669597712 NPI number — ATCHISON HOLT AMBULANCE DISTRICT

Table of content: (NPI 1669597712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669597712 NPI number — ATCHISON HOLT AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATCHISON HOLT 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:
1669597712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARKIO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-736-5216
Provider Business Mailing Address Fax Number:
660-744-6066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARKIO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64491-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-736-5216
Provider Business Practice Location Address Fax Number:
660-736-4892
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRADLEY
Authorized Official First Name:
DYMOND
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EMS CHIEF
Authorized Official Telephone Number:
660-736-5216

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  005002 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 5002 , 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: 800492506 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com