Provider Demographics
NPI:1003815333
Name:HOWARD COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:HOWARD COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-248-2229
Mailing Address - Street 1:100 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1086
Mailing Address - Country:US
Mailing Address - Phone:660-248-2229
Mailing Address - Fax:660-248-2371
Practice Address - Street 1:100 S WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1086
Practice Address - Country:US
Practice Address - Phone:660-248-2229
Practice Address - Fax:660-248-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089001341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800546301Medicaid
MO800546301Medicaid