MEDICARE: NORTH SCOTT COUNTY AMBULANCE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	201031	MO

General Provider Information

NPI Number	:	1265594485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SCOTT COUNTY AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	28825 US HIGHWAY 61
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-9137
Country	:	US
Telephone Number	:	573-887-6311
Fax Number	:	573-264-2881

Provider Business Practice Location Address
First Line	:	28825 US HIGHWAY 61
Second Line	:
City	:	SCOTT CITY
State	:	MO
Zip	:	63780-9137
Country	:	US
Telephone Number	:	573-887-6311
Fax Number	:	573-264-2881

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LARRY CHASTEEN
Credential	:
Telephone Number	:	573-887-6311

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/31/2022

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