Healthcare Provider Details

I. General information

NPI: 1962528760
Provider Name (Legal Business Name): WEST CARTER COUNTY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MAIN ST.
VAN BUREN MO
63965-0160
US

IV. Provider business mailing address

PO BOX 160
VAN BUREN MO
63965-0160
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-4791
  • Fax: 573-323-8030
Mailing address:
  • Phone: 573-323-4791
  • Fax: 573-323-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number035009
License Number StateMO

VIII. Authorized Official

Name: MR. MICHAEL C KENNEDY
Title or Position: EMS MANAGER
Credential: EMT-P
Phone: 573-323-4791