=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174735930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCK TOWNSHIP AMBULANCE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6707 SAINT LUKES CHURCH RD
-----------------------------------------------------
City | BARNHART
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63012-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-296-5066
-----------------------------------------------------
Fax | 636-296-8357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6707 SAINT LUKES CHURCH RD
-----------------------------------------------------
City | BARNHART
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63012-1182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-296-5066
-----------------------------------------------------
Fax | 636-296-8357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER ELLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-296-5066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 099091
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------