Healthcare Provider Details

I. General information

NPI: 1386868032
Provider Name (Legal Business Name): IRON COUNTY EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VINE STREET
VIBURNUM MO
65566
US

IV. Provider business mailing address

PO BOX 331 15 VINE STREET
VIBURNUM MO
65566-0331
US

V. Phone/Fax

Practice location:
  • Phone: 573-244-5966
  • Fax: 573-244-5959
Mailing address:
  • Phone: 573-244-5966
  • Fax: 573-244-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number093017
License Number StateMO

VIII. Authorized Official

Name: MR. JOHNNY R SETZER
Title or Position: MANAGER
Credential: EMT PARAMEDIC
Phone: 573-244-5966