MEDICARE: CITY OF INDEPENDENCE

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	850	KS

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

General Provider Information

NPI Number	:	1326043613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF INDEPENDENCE

Provider Business Mailing Address
First Line	:	120 N 6TH ST
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3759
Country	:	US
Telephone Number	:	620-332-2528
Fax Number	:	620-331-1628

Provider Business Practice Location Address
First Line	:	120 N 6TH ST
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3759
Country	:	US
Telephone Number	:	620-332-2528
Fax Number	:	620-331-1628

Authorized Official
Title or Position	:	DIRECTOR OF PUBLIC SAFETY
Name	:	MR. DAVID JAMES COWAN
Credential	:	MICT-LPN
Telephone Number	:	620-332-2528

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/20/2012

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Directions to “CITY OF INDEPENDENCE ” Practice Location

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