Healthcare Provider Details

I. General information

NPI: 1174679906
Provider Name (Legal Business Name): CITY OF MOUNDRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N WEDEL AVE
MOUNDRIDGE KS
67107-7540
US

IV. Provider business mailing address

225 N WEDEL AVE
MOUNDRIDGE KS
67107-7540
US

V. Phone/Fax

Practice location:
  • Phone: 620-345-3657
  • Fax: 620-345-3665
Mailing address:
  • Phone: 620-345-3657
  • Fax: 620-345-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1350
License Number StateKS

VIII. Authorized Official

Name: ANGIE VICKREY
Title or Position: BILLING
Credential:
Phone: 620-345-3657