Healthcare Provider Details

I. General information

NPI: 1376637157
Provider Name (Legal Business Name): CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MILITARY AVENUE
BAXTER SPRINGS KS
66713-0137
US

IV. Provider business mailing address

P.O. BOX 137
BAXTER SPRINGS KS
66713-0137
US

V. Phone/Fax

Practice location:
  • Phone: 620-856-2561
  • Fax: 620-856-3585
Mailing address:
  • Phone: 620-856-2561
  • Fax: 620-856-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number300
License Number StateKS

VIII. Authorized Official

Name: MR. RONALD JAMES COSTLOW
Title or Position: SERVICE DIRECTOR
Credential: PARAMEDIC
Phone: 620-856-2561