Healthcare Provider Details

I. General information

NPI: 1750380044
Provider Name (Legal Business Name): TANEY COUNTY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 INDUSTRIAL PARK DR
HOLLISTER MO
65672-5392
US

IV. Provider business mailing address

PO BOX 460
BRANSON MO
65615-0460
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-6586
  • Fax:
Mailing address:
  • Phone: 417-334-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number213021
License Number StateMO

VIII. Authorized Official

Name: COLBY STOCKSTILL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 417-334-6586