Healthcare Provider Details

I. General information

NPI: 1639112626
Provider Name (Legal Business Name): COMM-UNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/25/2021
Certification Date: 04/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N WALNUT
META MO
65058-0132
US

IV. Provider business mailing address

PO BOX 132
META MO
65058-0132
US

V. Phone/Fax

Practice location:
  • Phone: 573-229-8902
  • Fax: 573-229-8902
Mailing address:
  • Phone: 573-616-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number151025
License Number StateMO

VIII. Authorized Official

Name: BRENDA K WANSING
Title or Position: OFFICE MANAGER
Credential:
Phone: 573-616-8715