Healthcare Provider Details

I. General information

NPI: 1417120916
Provider Name (Legal Business Name): REYNOLDS COUNTY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 BUFORD ST
CENTERVILLE MO
63633
US

IV. Provider business mailing address

PO BOX 224
CENTERVILLE MO
63633-0224
US

V. Phone/Fax

Practice location:
  • Phone: 573-429-5512
  • Fax: 573-648-2555
Mailing address:
  • Phone: 636-294-4632
  • Fax: 800-583-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number179001
License Number StateMO

VIII. Authorized Official

Name: MR. JD JADELOVICZ
Title or Position: ADMINISTRATOR
Credential: NRP
Phone: 573-429-5512