MEDICARE: CITY OF EXCELSIOR SPRINGS

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	341600000X	Ambulance	047074	MO
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285637058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF EXCELSIOR SPRINGS

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-8642

Provider Business Practice Location Address
First Line	:	1120 TRACY AVE.
Second Line	:
City	:	EXCELSIOR SPRINGS
State	:	MO
Zip	:	64024-1141
Country	:	US
Telephone Number	:	816-630-3000
Fax Number	:	816-630-9530

Authorized Official
Title or Position	:	ASST. CHIEF
Name	:	ZACHARY ST JOHN
Credential	:
Telephone Number	:	816-630-3000

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/01/2022

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Directions to “CITY OF EXCELSIOR SPRINGS ” Practice Location

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