Healthcare Provider Details

I. General information

NPI: 1154617579
Provider Name (Legal Business Name): OREGON COUNTY AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 WEST WALNUT ST
THAYER MO
65791-1277
US

IV. Provider business mailing address

PO BOX 163
THAYER MO
65791
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-2145
  • Fax: 888-965-4620
Mailing address:
  • Phone: 319-291-4279
  • Fax: 888-965-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number149012
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KENNETH MCKENZIE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-264-2145