1194929240 NPI number — EAST CARTER COUNTY VOLUNTEER AMBULANCE

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 1194929240 NPI number — EAST CARTER COUNTY VOLUNTEER AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST CARTER COUNTY VOLUNTEER AMBULANCE
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:
1194929240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
RT.2 BOX 2004
Provider Business Mailing Address City Name:
ELLSINORE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63937-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-322-8303
Provider Business Mailing Address Fax Number:
573-322-8303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RT. 2 BOX 2004
Provider Second Line Business Practice Location Address:
SOUTH SIDE HWY. A AT WEST CITY LIMITS
Provider Business Practice Location Address City Name:
ELLSINORE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63937-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-322-8303
Provider Business Practice Location Address Fax Number:
573-322-8303
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUCKETT
Authorized Official First Name:
ERMA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BOOKKEEPER CREW CHIEF
Authorized Official Telephone Number:
573-322-8303

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  4595 , 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: 800628109 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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