1912057571 NPI number — SEMO EMS INC

Table of content: (NPI 1912057571)

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".