Healthcare Provider Details

I. General information

NPI: 1083648711
Provider Name (Legal Business Name): VILLAGE OF CLAYCOMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 69 HIGHWAY
CLAYCOMO MO
64119
US

IV. Provider business mailing address

333 E 69 HIGHWAY
CLAYCOMO MO
64119
US

V. Phone/Fax

Practice location:
  • Phone: 816-452-4612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRUCE BUTLER
Title or Position: MANAGER
Credential:
Phone: 816-452-4612