1477550937 NPI number — DEKALB CLINTON AMBULANCE DISTRICT NO 1

Table of content: (NPI 1477550937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477550937 NPI number — DEKALB CLINTON AMBULANCE DISTRICT NO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEKALB CLINTON AMBULANCE DISTRICT NO 1
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:
1477550937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
261 SE OFFUTT RD
Provider Second Line Business Mailing Address:
PO BOX 501
Provider Business Mailing Address City Name:
MAYSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64469-9149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-669-3642
Provider Business Mailing Address Fax Number:
816-669-3642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 SE OFFUTT RD
Provider Second Line Business Practice Location Address:
PO 501
Provider Business Practice Location Address City Name:
MAYSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64469-9149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-669-3642
Provider Business Practice Location Address Fax Number:
816-669-3642
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
816-669-3642

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  063002 , 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: T02666154 . This is a "VA CHAMPUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 08167011 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 590077838A . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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