MEDICARE: CLARK 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	045004	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	155574	OTHER	MO	BC/BS OF MISSOURI
2	ITS99	OTHER	IA	WELLMARK BC/BS OF IOWA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558340877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK COUNTY AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	211 N VINE ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1283
Country	:	US
Telephone Number	:	660-727-3612
Fax Number	:	660-727-2182

Provider Business Practice Location Address
First Line	:	211 N VINE ST
Second Line	:
City	:	KAHOKA
State	:	MO
Zip	:	63445-1283
Country	:	US
Telephone Number	:	660-727-3612
Fax Number	:	660-727-2182

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. CINDA I JAMES
Credential	:
Telephone Number	:	660-727-3612

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/22/2020

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Directions to “CLARK COUNTY AMBULANCE DISTRICT ” Practice Location

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