Healthcare Provider Details

I. General information

NPI: 1841307717
Provider Name (Legal Business Name): MERAMEC AMBULANCE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3279 HIGHWAY 100
VILLA RIDGE MO
63089-1477
US

IV. Provider business mailing address

3279 HIGHWAY 100
VILLA RIDGE MO
63089-1477
US

V. Phone/Fax

Practice location:
  • Phone: 636-451-5816
  • Fax: 636-451-5835
Mailing address:
  • Phone: 636-451-5816
  • Fax: 636-451-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number071021
License Number StateMO

VIII. Authorized Official

Name: MARY ANN RETHMEIER
Title or Position: LIEUTENANT
Credential: P13143
Phone: 636-451-5816