Healthcare Provider Details

I. General information

NPI: 1477550937
Provider Name (Legal Business Name): DEKALB CLINTON AMBULANCE DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 SE OFFUTT RD PO 501
MAYSVILLE MO
64469-9149
US

IV. Provider business mailing address

261 SE OFFUTT RD PO BOX 501
MAYSVILLE MO
64469-9149
US

V. Phone/Fax

Practice location:
  • Phone: 816-669-3642
  • Fax: 816-669-3642
Mailing address:
  • Phone: 816-669-3642
  • Fax: 816-669-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number063002
License Number StateMO

VIII. Authorized Official

Name: MRS. ROSE L BARNES
Title or Position: SUPERVISOR
Credential:
Phone: 816-669-3642