Healthcare Provider Details

I. General information

NPI: 1770621542
Provider Name (Legal Business Name): DIXON AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S. ELLEN ST.
DIXON MO
65459
US

IV. Provider business mailing address

PO BOX 396
DIXON MO
65459-0396
US

V. Phone/Fax

Practice location:
  • Phone: 573-759-7447
  • Fax: 573-759-7098
Mailing address:
  • Phone: 573-759-7447
  • Fax: 573-759-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number169021
License Number StateMO

VIII. Authorized Official

Name: JANET MARIE DRISCOLL
Title or Position: ADMINISTRATOR
Credential: EMTP
Phone: 573-759-7447