Healthcare Provider Details

I. General information

NPI: 1174735930
Provider Name (Legal Business Name): ROCK TOWNSHIP AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 SAINT LUKES CHURCH RD
BARNHART MO
63012-1182
US

IV. Provider business mailing address

6707 SAINT LUKES CHURCH RD
BARNHART MO
63012-1182
US

V. Phone/Fax

Practice location:
  • Phone: 636-296-5066
  • Fax: 636-296-8357
Mailing address:
  • Phone: 636-296-5066
  • Fax: 636-296-8357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number099091
License Number StateMO

VIII. Authorized Official

Name: JENNIFER ELLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-296-5066