Healthcare Provider Details

I. General information

NPI: 1700883253
Provider Name (Legal Business Name): VALLE AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12363 STATE ROUTE 21
DE SOTO MO
63020
US

IV. Provider business mailing address

12363 STATE ROUTE 21
DESOTO MO
63020
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-2132
  • Fax: 636-586-4436
Mailing address:
  • Phone: 636-586-2132
  • Fax: 636-586-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number099082
License Number StateMO

VIII. Authorized Official

Name: MR. JESSE E BARTON
Title or Position: CHIEF
Credential: PARAMEDIC P-15066
Phone: 636-586-2132