Healthcare Provider Details

I. General information

NPI: 1417126822
Provider Name (Legal Business Name): DONALD RAY MEADE EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 BUFORD STREET
CENTERVILLE MO
63633
US

IV. Provider business mailing address

2281 BUFORD STREET
CENTERVILLE MO
63633
US

V. Phone/Fax

Practice location:
  • Phone: 573-663-7628
  • Fax:
Mailing address:
  • Phone: 573-663-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1790001
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number179001
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: