Healthcare Provider Details

I. General information

NPI: 1215354923
Provider Name (Legal Business Name): CITY OF EDWARDSVILLE KS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 S 4TH ST
EDWARDSVILLE KS
66111-1390
US

IV. Provider business mailing address

690 S 4TH ST
EDWARDSVILLE KS
66111-1390
US

V. Phone/Fax

Practice location:
  • Phone: 913-422-5460
  • Fax: 913-422-8206
Mailing address:
  • Phone: 913-441-3707
  • Fax: 913-441-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL WEBB
Title or Position: CITY MANAGER
Credential:
Phone: 913-441-3707