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General NPI Number Information
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NPI Number | 1376637157
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Entity Type | Organization
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Legal Business Name | CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 311 MILITARY AVENUE
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City | BAXTER SPRINGS
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State | KS
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Zip | 66713-0137
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Country | US
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Telephone | 620-856-2561
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Fax | 620-856-3585
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Provider Business Mailing Address
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Address Line | P.O. BOX 137
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City | BAXTER SPRINGS
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State | KS
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Zip | 66713-0137
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Country | US
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Telephone | 620-856-2561
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Fax | 620-856-3585
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Authorized Official
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Title or Position | SERVICE DIRECTOR
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Name | MR. RONALD JAMES COSTLOW
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Credential | PARAMEDIC
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Telephone | 620-856-2561
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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 | 300
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License Number State | KS
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