Healthcare Provider Details

I. General information

NPI: 1174501050
Provider Name (Legal Business Name): CITY OF GOLDEN CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DEPOT AVE
GOLDEN CITY MO
64748-9999
US

IV. Provider business mailing address

701 DEPOT AVE
GOLDEN CITY MO
64748
US

V. Phone/Fax

Practice location:
  • Phone: 417-537-4351
  • Fax: 417-537-8593
Mailing address:
  • Phone: 417-537-4351
  • Fax: 417-537-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number011002
License Number StateMO

VIII. Authorized Official

Name: MR. JOE BREWER
Title or Position: MAYOR
Credential:
Phone: 417-537-4351