Healthcare Provider Details

I. General information

NPI: 1194929240
Provider Name (Legal Business Name): EAST CARTER COUNTY VOLUNTEER AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 2 BOX 2004 SOUTH SIDE HWY. A AT WEST CITY LIMITS
ELLSINORE MO
63937-0160
US

IV. Provider business mailing address

PO BOX 160 RT.2 BOX 2004
ELLSINORE MO
63937-0160
US

V. Phone/Fax

Practice location:
  • Phone: 573-322-8303
  • Fax: 573-322-8303
Mailing address:
  • Phone: 573-322-8303
  • Fax: 573-322-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number4595
License Number StateMO

VIII. Authorized Official

Name: MS. ERMA E DUCKETT
Title or Position: BOOKKEEPER CREW CHIEF
Credential: PARAMEDIC
Phone: 573-322-8303