MEDICARE: CLERIC RAY GLADNEY JR.

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	343900000X	Non-emergency Medical Transport (VAN)		MO

General Provider Information

NPI Number	:	1871430124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLERIC RAY GLADNEY JR.

Provider Business Mailing Address
First Line	:	716 SUNSET LN
Second Line	:	716 SUNSET LN
City	:	O FALLON
State	:	MO
Zip	:	63366-2278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 SUNSET LN
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63366-2278
Country	:	US
Telephone Number	:	314-610-3159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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