Healthcare Provider Details

I. General information

NPI: 1770568743
Provider Name (Legal Business Name): MARTHASVILLE COMMUNITY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH STREET
MARTHASVILLE MO
63357-0182
US

IV. Provider business mailing address

PO BOX 182
MARTHASVILLE MO
63357-0182
US

V. Phone/Fax

Practice location:
  • Phone: 636-433-5262
  • Fax: 636-433-5902
Mailing address:
  • Phone: 636-433-5262
  • Fax: 636-433-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number219011
License Number StateMO

VIII. Authorized Official

Name: MR. LARRY BREWE
Title or Position: BOARD CHAIRMAN
Credential:
Phone: 636-433-5262