Healthcare Provider Details

I. General information

NPI: 1336342815
Provider Name (Legal Business Name): NAYLOR-NEELYVILLE AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NORTH FRONT STREET
NAYLOR MO
63953
US

IV. Provider business mailing address

PO BOX 1246
POPLAR BLUFF MO
63902-1246
US

V. Phone/Fax

Practice location:
  • Phone: 573-399-2727
  • Fax: 573-399-2727
Mailing address:
  • Phone: 573-785-3861
  • Fax: 573-785-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number181013
License Number StateMO

VIII. Authorized Official

Name: BRAD JOSEPH DAVIS
Title or Position: DIRECTOR
Credential: EMT-RN
Phone: 573-399-2727