1356460273 NPI number — ANDREW COUNTY AMBULANCE DISTRICT

Table of content: (NPI 1356460273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356460273 NPI number — ANDREW COUNTY AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW COUNTY 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:
1356460273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-824-8123
Provider Business Mailing Address Fax Number:
270-824-8140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64485-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-324-3341
Provider Business Practice Location Address Fax Number:
816-324-6467
Provider Enumeration Date:
03/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUDEL
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-897-0549

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  003018 , 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: 802605600 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125283715 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08215015 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100243450A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".