Healthcare Provider Details

I. General information

NPI: 1083740245
Provider Name (Legal Business Name): LAKE OZARK FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 BAGNELL DAM BLVD.
LAKE OZARK MO
65049-9734
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 573-365-3380
  • Fax: 573-365-3758
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number46568
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3416S0300X
TaxonomyWater Ambulance
License Number029050
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HEGEL
Title or Position: DEPUTY CHIEF
Credential:
Phone: 573-745-0049