Healthcare Provider Details

I. General information

NPI: 1699005082
Provider Name (Legal Business Name): OZARK COUNTY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 31
GAINESVILLE MO
65655-9601
US

IV. Provider business mailing address

HC 1 BOX 31
GAINESVILLE MO
65655-9601
US

V. Phone/Fax

Practice location:
  • Phone: 417-679-3624
  • Fax: 417-679-3597
Mailing address:
  • Phone: 417-679-3624
  • Fax: 417-679-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number153001
License Number StateMO

VIII. Authorized Official

Name: MR. RAY PETER
Title or Position: BOARD PRESIDENT
Credential:
Phone: 417-261-2863