1932111259 NPI number — WARREN COUNTY AMBULANCE DISTRICT

Table of content: (NPI 1932111259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932111259 NPI number — WARREN COUNTY AMBULANCE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN 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:
1932111259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 FAIRGROUNDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63383-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-456-8413
Provider Business Mailing Address Fax Number:
636-456-1147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63383-4420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-456-8413
Provider Business Practice Location Address Fax Number:
636-456-1147
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HELLEBUSCH
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
V
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
636-456-8413

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  219029 , 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: 9000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073897 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29687 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 238896 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".