1912057571 NPI number — SEMO EMS INC

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 1912057571 NPI number — SEMO EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEMO EMS INC
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:
BOLLINGER COUNTY EMS
Provider Other Organization Name Type Code:
5
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:
1912057571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARBLE HILL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63764-0091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-238-4837
Provider Business Mailing Address Fax Number:
573-238-3228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 2 BOX 2162
Provider Second Line Business Practice Location Address:
HWY 34 EAST
Provider Business Practice Location Address City Name:
MARBLE HILL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63764-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-238-4837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TUCKER
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-238-3059

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  017051 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 017019 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 130913 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806927901 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 800461808 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com