Healthcare Provider Details

I. General information

NPI: 1013961259
Provider Name (Legal Business Name): RAY COUNTY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 WOLLARD BLVD
RICHMOND MO
64085-1928
US

IV. Provider business mailing address

PO BOX 514
RICHMOND MO
64085-0514
US

V. Phone/Fax

Practice location:
  • Phone: 816-470-3030
  • Fax:
Mailing address:
  • Phone: 816-470-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number17708
License Number StateMO

VIII. Authorized Official

Name: SAMMY MOPPIN
Title or Position: EMS COORDINATOR
Credential:
Phone: 816-470-3030