1376637157 NPI number — CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III

Table of content: (NPI 1376637157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376637157 NPI number — CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III
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:
1376637157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAXTER SPRINGS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66713-0137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-856-2561
Provider Business Mailing Address Fax Number:
620-856-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 MILITARY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66713-0137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-856-2561
Provider Business Practice Location Address Fax Number:
620-856-3585
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COSTLOW
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
620-856-2561

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  300 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590006034 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 801647603 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100817370A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005547 . This is a "BLUE CROSS/BLUE SHIELD #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100091570A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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