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General NPI Number Information
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NPI Number | 1114076296
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Entity Type | Organization
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Legal Business Name | STODDARD COUNTY AMBULANCE DISTRICT
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 W BUSINESS US HIGHWAY 60
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City | DEXTER
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State | MO
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Zip | 63841-1027
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Country | US
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Telephone | 573-624-4528
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Fax | 573-624-8648
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | DEXTER
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State | MO
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Zip | 63841-0125
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Country | US
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Telephone | 573-624-4528
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Fax | 573-624-8648
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID R COOPER
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Credential |
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Telephone | 573-624-4528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 207004
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License Number State | MO
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